Surgical treatment of brain metastases

Objective. Cerebral metastases are the most common tumors within the brain accounting for 30-40% of tumors. Surgery is one of the relevant treatment options. In this article the indications for surgery of isolated, multiple and recurrent brain metastases as well as the results achieved will be critically evaluated. Material and methods. Prospective randomized and current retrospective trials (evidence level 1-3) were evaluated. Innovative surgical technical aspects are discussed. Results. There are indications for surgery if metastases have a mass-occupying effect and are situated in the cortex or subcortex of the cerebrum or cerebellum. The median overall survival time of patients with an isolated brain lesion is about 1 year depending on the primary tumor (evidence level 2). Patients with multiple brain metastases profit from surgery if they are categorized as recursive partitioning analysis (RPA) class 1, the number of lesions does not extend to more than 3 and all lesions can be removed (evidence level 3). In cases of recurrent tumor growth surgery is indicated if the lesion is space-occupying, radiotherapy or radiosurgery have already been applied and there is an uncertainty about the histology of the lesion (e.g. necrosis or tumor regrowth). The patient should have a Karnofsky performance status scale (KPS) score >70 (evidence level 3). Conclusion. Surgery is a valuable treatment option for brain metastases. Patients with isolated lesions particularly profit from surgery. A KPS score >70 is an essential parameter for the outcome and is also of importance for patients with multiple lesions and recurrent tumor growth. Adjuvant whole brain radiation therapy reduces local and distant recurrent growth but does not prolong the median overall survival time of patients. Innovative surgical techniques including the resection of a safety zone around the lesions can reduce local recurrence.