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

OBJECT 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

[1]  R. Delfini,et al.  Solitary brain metastases from non-oat cell lung cancer: clinical and prognostic features , 2004, Neurosurgical Review.

[2]  Akash J. Patel,et al.  Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. , 2008, Journal of neurosurgery.

[3]  G. Duncan,et al.  A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis , 1996, Cancer.

[4]  Posner Jb,et al.  Intracranial metastases from systemic cancer. , 1978 .

[5]  V T Farewell,et al.  The analysis of failure times in the presence of competing risks. , 1978, Biometrics.

[6]  J. Galicich,et al.  Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment , 1985, Cancer.

[7]  W R Markesbery,et al.  Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. , 1998, JAMA.

[8]  Ronald Brand,et al.  Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgery , 1993, Annals of neurology.

[9]  H. Budka,et al.  Pseudogliomatous growth pattern of anaplastic small cell carcinomas metastatic to the brain. , 2001, Clinical neuropathology.

[10]  Philippe Lambin,et al.  A pathology-based substrate for target definition in radiosurgery of brain metastases. , 2006, International journal of radiation oncology, biology, physics.

[11]  F. Barker.  Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000 , 2004, Cancer.

[12]  J. Zo,et al.  Reduced local recurrence of a single brain metastasis through microscopic total resection. , 2009, Journal of neurosurgery.

[13]  S. Cordera,et al.  Cerebral Metastases as First Symptom of Cancer: a Clinico-pathologic Study , 2000, Journal of Neuro-Oncology.

[14]  C. Vecht.  Clinical management of brain metastasis , 1998, Journal of Neurology.

[15]  K R Hess,et al.  Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. , 1998, Neurosurgery.

[16]  Akash J. Patel,et al.  COMPARATIVE RISK OF LEPTOMENINGEAL DISSEMINATION OF CANCER AFTER SURGERY OR STEREOTACTIC RADIOSURGERY FOR A SINGLE SUPRATENTORIAL SOLID TUMOR METASTASIS , 2009, Neurosurgery.

[17]  F. Barker.  Surgical and radiosurgical management of brain metastases. , 2005, The Surgical clinics of North America.

[18]  Y Maruyama,et al.  A randomized trial of surgery in the treatment of single metastases to the brain. , 1990, The New England journal of medicine.

[19]  Jill S Barnholtz-Sloan,et al.  Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.