Factors influencing the risk of local recurrence after resection of a single brain metastasis Clinical article

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 08/2010; 113(2):181-9. DOI: 10.3171/2009.11.JNS09659
Source: PubMed


Local recurrence (LR) of a resected brain metastasis occurs in up to 46% of patients. Postoperative whole-brain radiation therapy (WBRT) reduces that incidence. To isolate factors associated with the risk of LR after resection, the authors only studied patients who did not receive adjuvant radiotherapy.
The authors reviewed data from 570 cases involving patients who had undergone resection of a previously untreated single brain metastasis at The University of Texas M. D. Anderson Cancer Center between 1993 and 2006 without receiving postoperative WBRT. All tumors were measured preoperatively on MR images. The resection method (en bloc resection [EBR] or piecemeal resection [PMR]) was noted at the time of surgery. Predictors of LR were assessed using the Cox proportional hazards model.
The median patient age was 58 years, 55% were male, and 88% had a Karnofsky Performance Scale Score > or = 80. The most common primary cancers were those of the lung (28%), skin (melanoma, 21%), kidney (19%), and breast (11%). Piecemeal resection was performed in 201 patients (35%) and EBR in 369 (65%). Local recurrence developed in 84 patients (15%). The histological type of the primary cancer did not significantly predict LR; however, 7 of 22 patients with sarcoma developed LR (p = 0.16). The authors identified 2 variables that increased the risk of LR. Undergoing PMR carried a significantly higher LR risk than EBR (crude hazard ratio [HR] 1.7, 95% CI 1.1-2.6, p = 0.03). Tumors exceeding the median volume (9.7 cm(3)) had a significantly higher LR risk than those that were < 9.7 cm(3) (crude HR 1.7; 95% CI 1.1-2.6; p = 0.02). In the multivariate analysis, small tumors removed by EBR had a significantly lower LR risk.
The LR risk of a single brain metastasis is influenced by biological factors (such as tumor volume) and treatments (such as the resection method). Early administration of postoperative WBRT may be particularly warranted when such negative tumor-related prognostic factors are noted or when treatment-related ones such as PMR are unavoidable.

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    • "Previous work on the interface between cerebral metastases and the surrounding brain has been conducted using histological methods on surgically resected or post mortem specimens [36-38] and this has certainly suggested that there are different patterns and depths of invasion, even if this has not been related to clinical outcomes. Furthermore, it has been shown that wider resection margins may improve clinical survival [39] and that ADC changes across the border of another brain tumor - oligodendroglioma - may predict growth pattern and aggressiveness [21]. Novel therapies acting at the brain-metastasis interface are being developed [40], therefore more accurate non-invasive, radiological methods may be needed to assess the degree of invasion of cerebral metastases and characterise the tumor boundary changes seen at diffusion-weighted MRI. "
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    • "Of all malignant tumours, MM has the highest propensity to metastasize to the brain [2]. Approximately 10–13% of patients presenting with regional disease (American Joint Committee on Cancer (AJCC) stage III) are at risk for brain metastases [3] [4] and 18–46% of stage IV patients will develop central nervous system (CNS) involvement [3] [5] with a prevalence of 55–75% at autopsy [5] [6] [7] [8]. The prognosis after diagnosis of BM of MM is poor with a median survival of only a few months [9] [10] [11] [12]. "
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    Clinical neurology and neurosurgery 04/2013; 115(9). DOI:10.1016/j.clineuro.2013.03.019 · 1.13 Impact Factor
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    • "Furthermore, evidence suggests that an en bloc resection may be beneficial compared with piecemeal resection for supra- and infra-tentorial situated cerebral metastases. In addition to the type of resection, preoperative tumour volume significantly influences the incidence of local recurrence [10–12]. However, although complete en bloc resection should be aspired to, is not possible in all patients when metastases are localised in eloquent-brain areas and are adherent or infiltrate adjacent brain tissue. "
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