Brain Metastases: Surgical Treatment and Overall Survival.
BACKGROUND
Brain metastases occur in 10%-40% of patients with cancer and are more common than primary brain tumors (30%-40%); their incidence is growing because of improvements in control of systemic disease, better radiologic detection, and prolonged survival. Modern treatment of brain metastases has dramatically changed the expected prognosis. Traditionally, the prognosis has been considered very poor, and patients were referred to palliative treatment because of their terminal stage; however, new prognostic indexes have been proposed to evaluate these patients. The aim of our study was to determine the long-term effect of surgery on overall survival (OS) in patients with brain metastases from dissimilar primary tumors and to identify prognostic variables associated with prolonged survival.


METHODS
We retrospectively reviewed a consecutive series of patients who underwent surgery between January 2010 and October 2014 for cerebral metastases from lung, kidney, breast, and gastrointestinal cancers and melanoma. Variables included age; sex; histology; location of lesions; and specific treatments patients had undergone including chemotherapy, radiotherapy, and surgery, individually or combined.


RESULTS
No patients deteriorated after surgery. At discharge, 19 patients (26.76%) had an unchanged postoperative neurologic examination, whereas 52 patients (73.23%) showed improvement (χ2= 34.84, P < 0.0001). Expected OS, considering all tumor subtypes, was 372.24 months; the patients in our series had an OS of 787 months, more than twice the expected OS; specifically, average expected survival of each patient was 5.24 months, whereas actual survival was 11.08 months (P = 0.000008).


CONCLUSIONS
Surgery is a safe and effective procedure for cerebral metastases and should not be considered an aggressive treatment in such disease. In our series, 55% of patients had a survival >6 months and a significant improvement in terms of actual versus expected survival. Surgical resection should be considered the primary option for patients with brain metastases.
Department of Neurosurgery, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy. Electronic address: gdandrea2002@yahoo.it.
Giancarlo
G
D'Andrea
Department of Oncology, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy.
Lucia
L
Palombi
Department of Radiation Oncology, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
Giuseppe
G
Minniti
Department of Neurosurgery, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy.
Alessandro
A
Pesce
Department of Oncology, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy.
Paolo
P
Marchetti
D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Brain metastases; Outcome; Overall survival; Prognostic factors