Abstract
Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection
(NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is
unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due
to neurologic causes, NSR may be controversial in other situations. Many aspects related
to NSR have not yet been well established, and the primary prognostic indices were
proposed only in the last decade. This study evaluates the survival and the morbidity,
causes of death, prognostic factors, and the impact of RT in patients with BMs treated
by NSR in the current era.
Methods A total of 200 patients with BMs who were treated by NSR were evaluated sequentially
and followed prospectively. We used logistic regression and Cox regression models
to identify independent factors associated with mortality at 4 weeks and at 1 year,
respectively. Clinical features, morbidity, recurrence, and causes of death were also
studied.
Results Lung cancer was the most prevalent cancer (36.5%); the median Karnofsky Performance
Status (KPS) score was 60. Total resection was achieved in 89%, and adjuvant RT was
applied in 63% of the cases. The rates of surgical mortality, morbidity, and mortality
at 4 weeks were 1.5%, 17%, and 7.5%, respectively. Systemic infections were the leading
cause of death in 62.5% of the cases. The median survival was 5 months, and 34.5%
of patients lived > 1 year. The postoperative KPS (KPSpo) score remained unchanged
or improved in 94.5% of the cases. In the multivariate analysis, a KPSpo score ≥ 80
and the application of adjuvant RT were associated with a lower risk of death at 12
weeks and at 1 year. Interestingly, the variables of primary tumor site, number of
BMs, and presence of carcinomatous meningitis were not significant.
Conclusion Morbidity and mortality were high, a third of the patients lived > 1 year, and the
KPS score improved or remained unchanged in most cases. Prognostic indices and health
conditions were important predictive factors, but the KPSpo score and adjuvant RT
were independent variables for survival at 12 weeks and at 1 year. Therefore, new
studies are needed to assess the influence of new therapies and specific molecular
profiles.
Keywords
surgery resection of brain metastases - prognostic factors - mortality - survival
- morbidity
