The role of surgery in the treatment of brain metastasis: a retrospective review

Background. To study the role of surgery for brain metastasis, we reviewed the records of 646 patients with brain metastasis. Methods. 340 patients underwent operative removal of the brain metastasis. During the same period, another 306 patients were treated without surgery. Criteria for surgery included the anatomical site, size over 3 cm, and cystic changes. Outcome was assessed by survival and cause of death. Treatment. 340 patients received surgical treatment, and 210 of these received radiation therapy. Another 306 patients were treated without surgery; 250 patients received conventional radiation and 56 patients were treated radiosurgically using a gamma knife. The surgical group was younger and had a better Karnofsky score than those of the non-surgical group. The median survival periods in the surgical and non-surgical groups were 21.0 months and 8.0 months, respectively. In patients whose brain lesions were first found before the systemic disease, the 5 year survival rates for the surgical and non-surgical groups were 35.2% and 18.2%, respectively. Although neurological causes accounted for 33.0% of deaths in the non-surgical group, and 13.2% of deaths in the surgical group; this difference was not significant. Conclusions. This retrospective review showed that patients with a brain metastasis treated surgically survived longer with better tumor control. To determine if this summary reflects the critical prognostic imbalance of population, further studies with randomized comparison are required.