Recurrent Brain Metastases: The Role of Resection of in a Comprehensive Multidisciplinary Treatment Setting

Abstract BackgroundTo evaluate the efficacy of surgical resection for pretreated, recurrent brain metastases (BM) in a comprehensive multidisciplinary treatment setting.MethodsIn a retrospective single center study, patients were analyzed who had undergone surgical resection of recurrent BM between 2007 and 2019. Intracranial event-free survival (EFS) and overall survival (OS) were evaluated by Kaplan-Maier and Cox regression analysis.ResultsIn total, 107 patients with different primary tumor entities and individual previous treatment for BM were included. Primary tumors comprised non-small cell lung cancer (NSCLC) (37.4%), breast cancer (19.6%), melanoma (13.1%), gastro-intestinal cancer (10.3%) and other, rare entities (19.6%). The number of previous treatments of BM ranged from one to four; these comprised: resection only, focal or whole brain radiotherapy, brachytherapy and radiosurgery. BM-related symptoms were present in 73.8% of the patients. Median pre-operative Karnofsky Performance Score (KPS) was 70% (range 40-100) which was improved to 80% (range 0-100) after surgery. The complication rate was 26.2% and two patients died during the perioperative period. Postoperative local radio-oncologic and/or systemic therapy regimens were applied in 67 (62.6%) patients. Median postoperative EFS and OS were 7.1 (95%CI 5.8-8.2) and 11.1 (95%CI 8.4-13.6) months, respectively. The clinical status (postoperative KPS >70 (HR 0.27 95%CI 0.16-0.46; p<0.001) remained the only independent factor for survival in multivariate analysis. Conclusion Surgical resection of recurrent BM may improve the clinical status and thus OS but is associated with a high complication rate; therefore, careful patient selection is crucial.