Surgical treatment of metastatic brain tumors

Lang, Frederick F.; Sawaya, Raymond

doi:10.1002/(sici)1098-2388(199801/02)14:1<53::aid-ssu7>3.0.co;2-1

Cited by 41 publications

(10 citation statements)

References 59 publications

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“…11,12,18,20,22,24–27,37,41 In two prospective, randomized trials assessing the value of surgical removal of single brain metastases among all ages, the mortality rates were 4% and 9%. 11,12 Unfortunately, the limited clinical depth of the NIS database made it impossible in the current study to quantify the number of brain metastases and to correlate it with outcome.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

et al. 2010

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Objective Risks of brain surgery in elderly patients with brain metastases are not well defined. This study was designed to quantify the postoperative risk for these patients after brain surgery for metastatic disease to the brain. Methods We performed a retrospective analysis of the Nationwide Inpatient Sample (1998–2005). Patients aged 65 years or older who underwent tumor resection of brain metastases were identified by ICD-9 coding. Primary outcome was inpatient death. Other outcomes included systemic postoperative complications, length of stay (LOS), and total charges. Results A total of 4,907 patients (53.6% men) were identified. Mean age was 72.1 years. Mean Charlson comorbidity score was 7.8. Inpatient mortality was 4%. The most common adverse events were pulmonary complications (3.4%). Mean length of stay was 9.2 days. Mean total charges were $57,596.39. In multivariate analysis, patients up to age 80 years had no significantly greater odds of inpatient death, relative to their 65- to 69-year-old counterparts. Each 1-point increase in Charlson score was associated with 12% increased odds of death, 0.52 days increased LOS, and $1,710.61 higher hospital charges. Postoperative pulmonary complications, stroke, or thromboembolic events increased LOS and total charges by up to 9.6 days and $57,664.42, respectively. These associations were statistically significant (P < 0.05). Conclusions Surgical resection of brain metastases among the elderly up to the ninth decade of life is feasible. Age older than 80 years and higher Charlson comorbidity scores were found to be important prognostic factors for inpatient outcome. Incorporating these factors into preoperative decision making may help to select appropriately those elderly candidates for neurosurgical intervention.

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Section: Discussionmentioning

confidence: 99%

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

et al. 2010

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“…33 Formerly, wholebrain radiotherapy combined, when feasible, with surgical resection was the treatment of choice. 30,48,49 As radiosurgery has begun to supplant surgical resection of brain metastases, the role of whole-brain radiotherapy also has been reassessed.…”

Section: Role Of Whole-brain Radiotherapy In Treatment Of Brain Metasmentioning

confidence: 99%

The role of the gamma knife in the treatment of malignant primary and metastatic brain tumors

Young¹

1998

CA: A Cancer Journal for Clinicians

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“…Surgery can extend survival, however it is dependent upon the lesions being resectable, and is often limited to single or a few lesions. 18 For most patients, there have been limited improvements in treatment, with median survival from 3 to 6 months and many patients dying of neurologic causes. 19 Treatment of metastatic tumors in the brain is more complicated than in the periphery because of the blood-brain barrier (BBB), which limits systemic delivery of chemotherapy and biologics.…”

Section: Introductionmentioning

confidence: 99%

Intracarotid delivery of oncolytic HSV vector G47Δ to metastatic breast cancer in the brain

2005

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Delivery of viral vectors to tumors in the brain is a challenge, especially via systemic administration, which is key to targeting the invasive margins of malignant glioma and the multiple foci of metastatic disease. Like for other cancer therapeutics, the blood-brain barrier or even the bloodtumor barrier significantly limits delivery and efficacy. Bloodbrain barrier disruption (BBBD) is one strategy for transiting the cerebrovasculature. G47D is a third-generation oncolytic replication-competent herpes simplex virus (HSV) vector, containing deletions of the g34.5 and a47 genes and an inactivating LacZ insertion in UL39 (ICP6). Intracarotid artery delivery of G47D after BBBD with 25% mannitol significantly extended the life of nude mice bearing intracerebral human MDA-MB-435 breast tumors, whereas, G47D injection contralateral to the tumor, in the absence of mannitol or mannitol alone had no effect on survival. G47D replication was extensive after BBBD, as visualized by X-gal staining. Staining of peripheral organs, lung and liver, was minimal and not altered by BBBD. This is the first demonstration of intracarotid arterial delivery of oncolytic HSV vectors and antitumor efficacy in a mouse model and opens the door to the use of mouse syngenic tumor models and transgenic/ knockout animals. Gene Therapy (2005) 12, 647-654.

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Surgical treatment of metastatic brain tumors

Cited by 41 publications

References 59 publications

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

The role of the gamma knife in the treatment of malignant primary and metastatic brain tumors

Intracarotid delivery of oncolytic HSV vector G47Δ to metastatic breast cancer in the brain

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