TY - JOUR
T1 - Role of Surgical Resection in Patients with Single Large Brain Metastases
T2 - Feasibility, Morbidity, and Local Control Evaluation
AU - Pessina, Federico
AU - Navarria, Pierina
AU - Cozzi, Luca
AU - Ascolese, Anna Maria
AU - Maggi, Giulia
AU - Rossi, Marco
AU - Riva, Marco
AU - Scorsetti, Marta
AU - Bello, Lorenzo
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objective The aim of this study was to evaluate the safety and the feasibility of surgery for single large brain metastases. Methods This retrospective study included 69 patients. All received a “supramarginal resection” according to functional boundaries, defined as a microsurgical excision with an extension larger at least 5 mm greater than the enhancing T1-weighted magnetic resonance imaging (MRI) sequence borders with dural attachment radicalization. Hypofractionated stereotactic radiosurgery on the tumor bed, using 30 Gy in 3 fractions, was performed within 1 month after surgery. Clinical outcome was evaluated at 30 days postoperative and by MRI performed every 3 months. The appearance of postoperative neurologic deficits, local control (LC), brain distant progression (BDP), and overall survival were evaluated. Results Clinical remission of symptomatology was obtained in 90.5% of patients. None of them had new neurologic deficits or worsening of preoperative functional status. No major complications or cerebrospinal fluid leakage occurred. No residual tumor was detected on postoperative MRI. The median follow-up was 24 months (range 4−33 months). The 1- to 2-year LC was 100%. Twenty-four (29% of) patients had new BDP, and 75% had extracranial progression. The median 1- to 2-year overall survival was 24 months, 91.3% and 73%. At the last observation time, 15 patients (21.7%) were dead and 54 patients (78.3%) were alive. Conclusion Supramarginal resection along with dural attachment radicalization have proved to be safe and effective for selected patients with single large brain metastases.
AB - Objective The aim of this study was to evaluate the safety and the feasibility of surgery for single large brain metastases. Methods This retrospective study included 69 patients. All received a “supramarginal resection” according to functional boundaries, defined as a microsurgical excision with an extension larger at least 5 mm greater than the enhancing T1-weighted magnetic resonance imaging (MRI) sequence borders with dural attachment radicalization. Hypofractionated stereotactic radiosurgery on the tumor bed, using 30 Gy in 3 fractions, was performed within 1 month after surgery. Clinical outcome was evaluated at 30 days postoperative and by MRI performed every 3 months. The appearance of postoperative neurologic deficits, local control (LC), brain distant progression (BDP), and overall survival were evaluated. Results Clinical remission of symptomatology was obtained in 90.5% of patients. None of them had new neurologic deficits or worsening of preoperative functional status. No major complications or cerebrospinal fluid leakage occurred. No residual tumor was detected on postoperative MRI. The median follow-up was 24 months (range 4−33 months). The 1- to 2-year LC was 100%. Twenty-four (29% of) patients had new BDP, and 75% had extracranial progression. The median 1- to 2-year overall survival was 24 months, 91.3% and 73%. At the last observation time, 15 patients (21.7%) were dead and 54 patients (78.3%) were alive. Conclusion Supramarginal resection along with dural attachment radicalization have proved to be safe and effective for selected patients with single large brain metastases.
KW - Large brain metastases
KW - Neurophysiologic monitoring
KW - Single large brain metastases
KW - Supramarginal resection
KW - Surgery in eloquent areas
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U2 - 10.1016/j.wneu.2016.06.098
DO - 10.1016/j.wneu.2016.06.098
M3 - Article
AN - SCOPUS:84984791943
VL - 94
SP - 6
EP - 12
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -