Results of surgical treatment of patients with multiple brain metastases

Objective: to evaluate the results of surgical treatment ofpatients with multiple brain metastases and to determine prognostic factors. Material and methods. 57 patients with multiple brain metastases were operated, 146 metastatic foci were removed. All metastases were removed in 42 persons; only large clinically significant metastases were removed in 15 patients. Whole brain radiation therapy was applied in 37patients, alone or in combination with chemotherapy, 20 patients after surgery received only corticosteroid and symptomatic therapy. Results. Median survival time of the whole group was 7.3 months; for patients, who received adjuvant whole brain radiation therapy - 11.6 months. Two-year survival was 8.8 %. The number of patients with Karnofsky performance score ≥ 70 increased from 12 persons (21,1%) at admission to the hospital to 38 (66.7 %) at 9-1th day after surgery. Median survival time for patients with complete resection was 9,2 months, with partial resection - 3,7 months. Prognostic factors were Karnofsky performance score and RPA class, estimated before operation, but after the corticosteroid therapy: median survival time for patients with RPA-class I was 19.5 monthsversus 5.6 months for patients with RPA- class II and III. Conclusions. Surgery rapidly improves the condition of patients with multiple brain metastases and saves the time for postoperative adjuvant treatment. Median survival time for patients who received adjuvant whole brain radiation therapy reaches 11.6 months. Favorable prognostic factors for prolonged survival are total resection of all lesions, RPA-class I and adjuvant whole brain radiation therapy.

Multiple brain metastases, Surgery, Prognostic factors