A randomized trial of surgery in the treatment of single metastases to the brain.

To assess the efficacy of surgical resection of brain metastases from extracranial primary cancer, we randomly assigned patients with a single brain metastasis to either surgical removal of the brain tumor followed by radiotherapy (surgical group) or needle biopsy and radiotherapy (radiation group). Forty-eight patients (25 in the surgical group and 23 in the radiation group) formed the study group; 6 other patients (11 percent) were excluded from the study because on biopsy their lesions proved to be either second primary tumors or inflammatory or infectious processes. Recurrence at the site of the original metastasis was less frequent in the surgical group than in the radiation group (5 of 25 [20 percent] vs. 12 of 23 [52 percent]; P less than 0.02). The overall length of survival was significantly longer in the surgical group (median, 40 weeks vs. 15 weeks in the radiation group; P less than 0.01), and the patients treated with surgery remained functionally independent longer (median, 38 weeks vs. 8 weeks in the radiation group; P less than 0.005). We conclude that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.

[1]  P. Ms,et al.  TRANYLCYPROMINE IN MULTIPLE SCLEROSIS. , 1965 .

[2]  J. Posner,et al.  Management of brain metastases. , 1992, Revue neurologique.

[3]  B. A. Lond,et al.  Andrew Moynihan Claye. , 1977, Lancet.

[4]  G. Krol,et al.  Distribution of brain metastases. , 1988, Archives of neurology.

[5]  S. George,et al.  Planning the size and duration of a clinical trial studying the time to some critical event. , 1974, Journal of chronic diseases.

[6]  G. Wampler,et al.  Intracerebral metastases in solid‐tumor patients: Natural history and results of treatment , 1981, Cancer.

[7]  E. Lang,et al.  METASTATIC BRAIN TUMORS. RESULTS OF SURGICAL AND NONSURGICAL TREATMENT. , 1964, The Surgical clinics of North America.

[8]  T. Deeley,et al.  Radiotherapy in the management of cerebral secondaries from bronchial carcinoma. , 1968, Lancet.

[9]  R. Gelber,et al.  The palliation of brain metastases in a favorable patient population: a randomized clinical trial by the Radiation Therapy Oncology Group. , 1981, International journal of radiation oncology, biology, physics.

[10]  J. Cairncross,et al.  Radation therapy for brain metastases , 1980 .

[11]  S. Hellman,et al.  Improvement in quality of survival following whole-brain irradiation for brain metastasis. , 1968, Radiology.

[12]  R. Parker,et al.  Irradiation of brain metastases. , 1974, Acta radiologica: therapy, physics, biology.

[13]  J. Miller,et al.  WHAT FOLLOWS DIAGNOSIS BY COMPUTED TOMOGRAPHY OF SOLITARY BRAIN TUMOUR? Audit of One Year's Experience in South East Scotland , 1987, The Lancet.

[14]  J. Ransohoff.  Surgical management of metastatic tumors. , 1975, Seminars in oncology.

[15]  G. Montana,et al.  Brain irradiation for metastatic disease of lung origin , 1972, Cancer.

[16]  N. Martini,et al.  The treatment of single brain metastasis from non‐oat cell lung: Carcinoma surgery and radiation. Versus radiation therapy alone , 1986, Cancer.

[17]  M. Rathbone,et al.  Postoperative contrast enhancement in patients with brain tumor , 1985, Annals of neurology.

[18]  A. Walker,et al.  Epidemiology of brain tumors , 1985, Neurology.

[19]  E. Macgee.  Surgical treatment of cerebral metastases from lung cancer. The effect on quality and duration of survival. , 1971, Journal of neurosurgery.

[20]  R. Gelber,et al.  The influence of surgery and radiation therapy on patients with brain metastases. , 1983, International journal of radiation oncology, biology, physics.

[21]  J. Braithwaite.  THE SIGNIFICANCE OF OXALURIA , 1930, British medical journal.

[22]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[23]  Posner Jb.  Diagnosis and treatment of metastases to the brain. , 1974 .

[24]  G. Hortobagyi,et al.  The natural history of breast cancer patients with brain metastases , 1979, Cancer.

[25]  N. Greig,et al.  Chemotherapy of brain metastases: current status. , 1984, Cancer treatment reviews.

[26]  J. Galicich,et al.  Surgical treatment of brain metastases from lung cancer. , 1983, Journal of neurosurgery.

[27]  A. Young,et al.  Treatment for patients with cerebral metastases. , 1978, Archives of neurology.

[28]  F. Grant.  CONCERNING INTRACRANIAL MALIGNANT METASTASES: THEIR FREQUENCY AND THE VALUE OF SURGERY IN THEIR TREATMENT. , 1926, Annals of surgery.

[29]  R. Gelber,et al.  Equivalence of radiation schedules for the palliative treatment of brain metastases in patients with favorable prognosis , 1981, Cancer.

[30]  M. D. T. P. Störtebecker.  Metastatic tumors of the brain from a neurosurgical point of view; a follow-up study of 158 cases. , 1954 .

[31]  T. Fleming,et al.  Single metastasis to the brain. Surgical treatment in 122 consecutive patients. , 1981, Mayo Clinic proceedings.

[32]  H. Thaler,et al.  Single brain metastases: surgery plus radiation or radiation alone , 1986, Neurology.

[33]  F. Hendrickson.  The optimun schedule for palliative radiotherapy for metastatic brain cancer. , 1977, International journal of radiation oncology, biology, physics.

[34]  K. Winston,et al.  Results of operative treatment of intracranial metastatic tumors , 1980, Cancer.

[35]  D. Karnofsky.  The clinical evaluation of chemotherapeutic agents in cancer , 1949 .

[36]  R. Vieth,et al.  Intracranial metastases and their neurosurgical treatment. , 1965, Journal of neurosurgery.

[37]  Stephan J. Goerss,et al.  Results of computed tomography-based computer-assisted stereotactic resection of metastatic intracranial tumors. , 1988, Neurosurgery.