Scholarlink

Background <p>Surgically accessible brain metastases are treated through microsurgical removal followed by radiation therapy, resulting in improved progression-free and overall survival. Some patients experience recurrence, prompting the need for effective management strategies. Despite the prevalence of recurrence, there remains a gap in the literature regarding the outcomes of patients undergoing re-resection of brain metastases.</p> Objectives <p>This study aims to comprehensively characterize clinical, radiological, histopathological, and treatment-related aspects, along with outcomes, for patients undergoing re-resection of locally and distantly recurrent brain metastases.</p> Methods <p>We conducted a single-center retrospective cohort study, including patients who underwent secondary brain metastasis resection following prior primary brain metastasis resection and irradiation.</p> Results <p>Among 60 patients, 41 (68.3%) had local recurrences, and 19 (31.7%) had distant recurrences. Median intracranial progression-free survival was 7.7 months [95% CI: 6.5–11.2], time to re-resection was 11.6 months [95% CI: 9.1–15.3], and overall survival was 30.8 months [95% CI: 20.4–49.5]. Non-small cell lung cancer (NSCLC) was the most common primary tumor. Post-initial resection treatments included radiation alone (31.7%), radiation plus chemotherapy (25.0%), radiation plus targeted therapy (15.0%), and radiation plus immunotherapy (28.3%). Cavity irradiation was performed in 46 patients (76.7%) and whole brain radiation in 14 (23.3%). Post-re-resection treatments varied: 21 patients (35.0%) received best supportive care, 15 (25.0%) radiation only, 12 (20.0%) systemic therapy only, and 12 (20.0%) both radiation and systemic therapy. Independent risk factors for shorter overall survival included non-breast cancer histology, pre-re-resection tumor volume &gt; 9 mL, pre-re-resection Karnofsky Performance Status ≤ 60%, and presence of vital tumor cells at re-resection.</p> Conclusion <p>Brain metastasis resection of local and distant recurrences is feasible and a treatment option for selected patients with good clinical performance status. This study underscores the potential role of re-resection in brain metastasis. Further research to improve patient selection and treatment algorithms is warranted.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Re-resection of brain metastases – outcomes of an institutional cohort study and literature review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年6月1日

查看全文
  • David Wasilewski,
  • Zoe Shaked,
  • Annalena Fuchs,
  • Siyer Roohani,
  • Ran Xu,
  • Max Schlaak,
  • Nikolaj Frost,
  • Martin Misch,
  • David Capper,
  • David Kaul,
  • Julia Onken,
  • Peter Vajkoczy,
  • Felix Ehret

摘要

Background

Surgically accessible brain metastases are treated through microsurgical removal followed by radiation therapy, resulting in improved progression-free and overall survival. Some patients experience recurrence, prompting the need for effective management strategies. Despite the prevalence of recurrence, there remains a gap in the literature regarding the outcomes of patients undergoing re-resection of brain metastases.

Objectives

This study aims to comprehensively characterize clinical, radiological, histopathological, and treatment-related aspects, along with outcomes, for patients undergoing re-resection of locally and distantly recurrent brain metastases.

Methods

We conducted a single-center retrospective cohort study, including patients who underwent secondary brain metastasis resection following prior primary brain metastasis resection and irradiation.

Results

Among 60 patients, 41 (68.3%) had local recurrences, and 19 (31.7%) had distant recurrences. Median intracranial progression-free survival was 7.7 months [95% CI: 6.5–11.2], time to re-resection was 11.6 months [95% CI: 9.1–15.3], and overall survival was 30.8 months [95% CI: 20.4–49.5]. Non-small cell lung cancer (NSCLC) was the most common primary tumor. Post-initial resection treatments included radiation alone (31.7%), radiation plus chemotherapy (25.0%), radiation plus targeted therapy (15.0%), and radiation plus immunotherapy (28.3%). Cavity irradiation was performed in 46 patients (76.7%) and whole brain radiation in 14 (23.3%). Post-re-resection treatments varied: 21 patients (35.0%) received best supportive care, 15 (25.0%) radiation only, 12 (20.0%) systemic therapy only, and 12 (20.0%) both radiation and systemic therapy. Independent risk factors for shorter overall survival included non-breast cancer histology, pre-re-resection tumor volume > 9 mL, pre-re-resection Karnofsky Performance Status ≤ 60%, and presence of vital tumor cells at re-resection.

Conclusion

Brain metastasis resection of local and distant recurrences is feasible and a treatment option for selected patients with good clinical performance status. This study underscores the potential role of re-resection in brain metastasis. Further research to improve patient selection and treatment algorithms is warranted.