Surgery in cerebral metastases: are numbers so important?

• Published in: Journal of cancer research and therapeutics 2014-01, Vol.10 (1), p.79-83
• Main Authors: Agnoletti, Alessandro, Mencarani, Camilla, Panciani, Pier Paolo, Buffoni, Lucio, Ronchetti, Gabriele, Spena, Giannantonio, Tartara, Fulvio, Buglione, Michela, Pagano, Manuela, Ducati, Alessandro, Fontanella, Marco, Garbossa, Diego
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain diseases; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Care and treatment; Excision (Surgery); Female; Health aspects; Humans; Male; Metastasis; Middle Aged; Patient outcomes; Postoperative Complications; Prognosis; Quality of life; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 0973-1482; 1998-4138
• DOI: 10.4103/0973-1482.131390

The prognosis of cerebral metastases (MTS) is linked to progression of both systemic and local disease. The importance of MTS resection has been already pointed out. The observation of a high mortality for not-neurological causes confirms that the modern treatments allow a significant control of the disease within the nervous system. Nevertheless, management difficulties increase with multiple lesions and in these cases the role of surgery has still to be defined. We collected the clinical data of patients operated in two centers for cerebral MTS from lung carcinoma during 8 years. Patient selection for surgery followed definite criteria; the limit for multiple MTS was three. We analyzed the functional and survival outcomes of the cohort. Our series included 242 patients: 105 had multiple MTS. Statistical analysis did not show significant differences in mean survival and outcomes between patients with single and multiple lesions. The decease occurred for neurological causes in 15.7% of cases. The selection of candidates for surgery requires several considerations and entails the success rate of this treatment. In patients with the multiple lesions who fulfilled the selection criteria we observed a nevertheless satisfying success after the operation. Our results imply that surgery may be applied also in selected patients with more diffuse intracranial disease. A pre-operative accurate patient selection is related to acceptable quality-of-life following the operation even in cases of multiple MTS.