Surgical resection and permanent iodine-125 brachytherapy for brain metastases

Abstract Background and Objective Surgical resection of brain metastases (BM) offers the highest rates of local control and survival; however, it is reserved for patients with good functional status. In particular, the presence of BM tends to oversize the detriment of the overall functional status, causing neurologic deterioration, potentially reversible following symptomatic pharmacological treatment. Thus, a timely indication of surgical resection may be dismissed. We propose to identify and quantify these variations in the functional status of patients with symptomatic BM to optimize the indication of surgical resection. Patients and Methods Historic, retrospective cohort analysis of adult patients undergoing BM microsurgical resection, consecutively from January 2012 to May 2016, was conducted. The Karnofsky performance status (KPS) variation was recorded according to the symptomatic evolution of each patient at specific moments of the diagnostic–therapeutic algorithm. Finally, survival curves were delineated for the main identified factors. Results One hundred and nineteen resection surgeries were performed. The median overall survival was 243 days, while on average it was 305.7 (95% confidence interval [CI]: 250.6–360.9) days. The indication of surgical resection of 10% of the symptomatic patients in our series (7.5% of overall) could have been initially rejected due to pharmacologically reversible neurologic impairment. Survival curves showed statistically significant differences when KPS was stratified following pharmacological symptomatic treatment (p < 0.0001), unlike when they were estimated at the time of BM diagnosis (p = 0.1128). Conclusion The preoperative determination of the functional status by KPS as an evolutive parameter after the nononcologic symptomatic pharmacological treatment allowed us to optimize the surgical indication of patients with symptomatic BM.

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Iodine-125 implant and external beam irradiation in patients with localized pancreatic carcinoma. A comparative study to surgical resection

Cancer ◽

10.1002/1097-0142(19800215)45:4<709::aid-cncr2820450416>3.0.co;2-5 ◽

1980 ◽

Vol 45 (4) ◽

pp. 709-714 ◽

Cited By ~ 87

Author(s):

William U. Shipley ◽

George L. Nardi ◽

Alfred M. Cohen ◽

C. Clifton Ling

Keyword(s):

Comparative Study ◽

Pancreatic Carcinoma ◽

Surgical Resection ◽

External Beam ◽

Beam Irradiation ◽

External Beam Irradiation ◽

Iodine 125

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161: Surgical Resection(S) Plus Stereotactic Radiosurgery (SRS) Versus SRS Alone for Large Brain Metastases: A Comparative Study

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)08877-0 ◽

2021 ◽

Vol 163 ◽

pp. S68

Author(s):

Barbara-Ann Millar ◽

Normand Laperriere ◽

Tatiana Conrad ◽

Aristotelis Kalyvas ◽

Gelareh Zadeh ◽

...

Keyword(s):

Brain Metastases ◽

Comparative Study ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Large Brain

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Surgical Resection for Brain Metastases

Central Nervous System Metastases ◽

10.1007/978-3-030-23417-1_16 ◽

2019 ◽

pp. 191-198

Author(s):

Ali S. Haider ◽

Raymond Sawaya ◽

Sherise D. Ferguson

Keyword(s):

Brain Metastases ◽

Surgical Resection

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Prolonged survival of patients with EGFR-mutated non-small cell lung cancer with solitary brain metastases treated with surgical resection of brain and lung lesions followed by EGFR TKIs

World Journal of Surgical Oncology ◽

10.1186/s12957-017-1252-y ◽

2017 ◽

Vol 15 (1) ◽

Cited By ~ 3

Author(s):

Qi Gui ◽

Jiangang Liu ◽

Dapeng Li ◽

Chengcheng Xu

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Surgical Resection ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Egfr Mutated ◽

Egfr Tkis ◽

Solitary Brain Metastases

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Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery

Neurosurgery ◽

10.1093/neuros/nyy436 ◽

2018 ◽

Vol 85 (5) ◽

pp. 632-641 ◽

Cited By ~ 6

Author(s):

Robert H Press ◽

Chao Zhang ◽

Mudit Chowdhary ◽

Roshan S Prabhu ◽

Matthew J Ferris ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Cumulative Incidence ◽

Postoperative Radiotherapy ◽

Multivariable Analysis ◽

Treatment Strategies ◽

Competing Risk ◽

Leptomeningeal Dissemination ◽

Increased Risk

Abstract BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.

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Resecting the Dominant Lesion: Patient Outcomes after Surgery and Radiosurgery vs Stand-Alone Radiosurgery in the Setting of Multiple Brain Metastases

10.21203/rs.3.rs-585469/v1 ◽

2021 ◽

Author(s):

Maria Punchak ◽

Stephen P Miranda ◽

Alexis Gutierrez ◽

Steven Brem ◽

Donald O'Rourke ◽

...

Keyword(s):

Brain Metastases ◽

Surgical Resection ◽

Gamma Knife Radiosurgery ◽

Median Number ◽

University Of Pennsylvania ◽

Multiple Brain Metastases ◽

The Us ◽

Median Diameter ◽

Similar Survival ◽

The University

Abstract BACKGROUND: Brain metastases are the most common central nervous system (CNS) tumors, occurring in 300,000 people per year in the US. The benefit of surgical resection, over radiosurgery, for dominant lesions remains unclear. METHODS: The University of Pennsylvania Health System database was retrospectively reviewed for patients presenting with multiple brain metastases from 1/1/16 to 8/31/18 with one dominant lesion > 2 cm in diameter, who underwent initial treatment with either resection of the dominant lesion or Gamma Knife radiosurgery (GKS). Inclusion criteria were age > 18, >1 brain metastasis, and presence of a dominant lesion (>2 cm). We analyzed factors associated with mortality. RESULTS: 129 patients were identified (surgery=84, GKS=45). The median number of intracranial metastases was 3 (IQR: 2-5). The median diameter of the largest lesion was 31 mm (IQR: 25-38) in the surgery group vs 21 mm (IQR: 20-24) in the GKS group (p<0.001). Mortality did not differ between surgery and GKS patients (69.1% vs 77.8%, p = 0.292). In a multivariate survival analysis, there was no difference in mortality between the surgery and GKS cohorts (aHR: 1.35, 95% CI: 0.74-2.45 p=0.32). Pre-operative KPS (aHR: 0.97, 95% CI: 0.95-0.99, p=0.004), CNS radiotherapy (aHR: 0.33, 95% CI: 0.19-0.56 p<0.001), chemotherapy (aHR: 0.27, 95% CI: 0.15-0.47, p<0.001), and immunotherapy (aHR: 0.41, 95% CI: 0.25-0.68, p=0.001) were associated with decreased mortality. CONCLUSION: In our institution, patients with multiple brain metastases and one symptomatic dominant lesion demonstrated similar survival after GKS when compared with up-front surgical resection of the dominant lesion.

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