Resection and Observation for Brain Metastasis without Prompt Postoperative Radiation Therapy.
10.3340/jkns.2017.0404.002
- Author:
Tae Wook SONG
1
;
In Young KIM
;
Shin JUNG
;
Tae Young JUNG
;
Kyung Sub MOON
;
Woo Youl JANG
Author Information
1. Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea. kiy87@hanmail.net
- Publication Type:Original Article
- Keywords:
Brain;
Metastasis;
Gamma knife radiosurgery;
Radiotherapy;
Stereotactic radiosurgery;
Surgery
- MeSH:
Brain*;
Breast;
Cerebellum;
Follow-Up Studies;
Gastrointestinal Tract;
Humans;
Kaplan-Meier Estimate;
Kidney;
Lung;
Magnetic Resonance Imaging;
Male;
Neoplasm Metastasis*;
Radiosurgery;
Radiotherapy;
Recurrence;
Survival Rate
- From:Journal of Korean Neurosurgical Society
2017;60(6):667-675
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Total resection without consecutive postoperative whole brain radiation therapy is indicated for patients with a single or two sites of brain metastasis, with close follow-up by serial magnetic resonance imaging (MRI). In this study, we explored the effectiveness, usefulness, and safety of this follow-up regimen. METHODS: From January 2006 to December 2015, a total of 109 patients (76 males, 33 females) underwent tumor resection as the first treatment for brain metastases (97 patients with single metastases, 12 with two metastases). The mean age was 59.8 years (range 27–80). The location of the 121 tumors in the 109 patients was supratentorial (n=98) and in the cerebellum (n=23). The origin of the primary cancers was lung (n=45), breast (n=17), gastrointestinal tract (n=18), hepatobiliary system (n=8), kidney (n=7), others (n=11), and unknown origin (n=3). The 121 tumors were totally resected. Follow-up involved regular clinical and MRI assessments. Recurrence-free survival (RFS) and overall survival (OS) after tumor resection were analyzed by Kaplan-Meier methods based on clinical prognostic factors. RESULTS: During the follow-up, MRI scans were done for 85 patients (78%) with 97 tumors. Fifty-six of the 97 tumors showed no recurrence without adjuvant local treatment, representing a numerical tumor recurrence-free rate of 57.7%. Mean and median RFS was 13.6 and 5.3 months, respectively. Kaplan-Meier analysis revealed the cerebellar location of the tumor as the only statistically significant prognostic factor related to RFS (p=0.020). Mean and median OS was 15.2 and 8.1 months, respectively. There were no significant prognostic factors related to OS. The survival rate at one year was 8.2% (9 of 109). CONCLUSION: With close and regular clinical and image follow-up, initial postoperative observation without prompt postoperative radiation therapy can be applied in patients of brain metastasi(e)s when both the tumor(s) are completely resected.
