Reoperation for recurrent metastatic brain tumors

Abstract

Results of reoperation in 48 patients who developed recurrent brain metastases between January 1984 and April 1993 are presented. Median time from first craniotomy to diagnosis of recurrence (time to recurrence) was 6.7 months. Median Karnofsky performance scale (KPS) score prior to reoperation was 80. Recurrence was local in 30 patients, distant in 16 patients, and both local and distant in two patients. Median survival time after reoperation was 11.5 months. There were no operative mortalities. Multivariate analysis revealed that presence of systemic disease (p = 0.008), KPS scores less than or equal to 70 (p = 0.008), time to recurrence of less than 4 months (p = 0.008), age greater than or equal to 40 years (p = 0.51), and primary tumor type of breast or melanoma (p = 0.028) negatively affected patient survival time. These five factors were used to develop a grading system (Grades I-IV). Patients categorized in Grade I had a 5-year survival rate of 57%, whereas the median survival time of patients in Grades II, III, and IV was 13.4, 6.8, and 3.4 months, respectively (p < 0.0001). Overall, 26 patients developed a second recurrence after reoperation. Seventeen patients underwent a second reoperation, whereas nine did not. Patients undergoing a second reoperation survived a median of 8.6 additional months versus 2.8 months for those who did not (p < 0.0001). This study concludes that reoperation for recurrent brain metastasis can prolong survival and improve quality of life. A second reoperation can also increase survival. Five factors influence survival: status of systemic disease, KPS score, time to recurrence, age, and type of primary tumor. The grading system using these five factors correlates with survival time. Reoperation should be approached with caution in Grade IV patients because of their poor prognosis.

Surgical Management of Single and Multiple Brain Metastases: Results of a Retrospective Study

“…There is an indication for re-operation if the time interval between the first cerebral metastasis and recurrent tumour growth is longer than 4 months and the patient has a Karnofsky score of more than 60 [31,32]. Patients can profit from surgical management in cases of recurrent tumour growth.…”

“…Patients can profit from surgical management in cases of recurrent tumour growth. In the publication by Bindal et al [32] median survival time ranged about 11.5 months. In our series 44 patients had tumour re-growth.…”

Treatment of Brain Metastases

“…Despite the known poor prognosis in this recurrent cohort, it appears that surgical resection of recurrent brain metastases may confer clinically significant survival and function improvement in carefully selected patients who may have exhausted other therapeutic modalities [15,16]. …”

Suitability and Limitations of Pointer-Based and Microscope-Based Neuronavigational Systems for Surgical Treatment of Intracerebral Tumours – a Comparative Study of 66 Patients

“…However, technical problems and brain shifting may occur during surgery, and its use should be restricted to experienced surgeons. As revealed by recent clinical studies, the prognosis of patients suffering from multiple intracerebral metastases can be improved by surgical excision if all lesions are accessible [10,11]. Accordingly, surgery may be considered as an alternative to radiosurgery in certain patients.…”