The role of surgical resection in patients with single large brain metastases: feasibility, morbidity and local control evaluation

Abstract

Objective

The aim of this study was to evaluate the safety and the feasibility of surgery for single large brain metastases.

Methods

This retrospective study included 69 patients. All received a “supramarginal resection” according with functional boundaries, defined as a microsurgical excision with an extension larger at least 5 mm than enhancing T1 weighted magnetic resonance imaging (MRI) sequences borders with dural attachment radicalization. Hypofractionated stereotactic radiosurgery on the tumor bed, using 30Gy in three fractions, was performed within one month after surgery. Clinical outcome was evaluated at thirty-days postoperative and by MRI performed every 3 months. The appearance of post-operative neurological deficits, local control (LC), brain distant progression (BDP) and overall survival (OS) were evaluated.

Results

Clinical remission of symptomatology was obtained in 90.5%. No patients had new neurological deficit or worsening of preoperative functional status. No major complications or cerebro-spinal fluid leakage occurred. No residual tumor was detected on postoperative-MRI. The median follow-up was 24 months (range 4-33 months). The 1-2- year LC was 100%. Twenty-four (29%) patients had new BDP and 75% also extracranial progression. The median, 1-2-year overall survival was 24 months, 91.3% and 73%. At the last observation time, 15 (21.7%) patients are dead and 54 (78.3%) alive.

Conclusion

Supramaginal resection along with dural attachment radicalization has proved to be a safe and effective strategy for selected patients with single large brain metastases.