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| Home > Publications database > Re-resection of brain metastases - outcomes of an institutional cohort study and literature review. |
| Journal Article (Review Article) | DKFZ-2025-01132 |
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2025
BioMed Central
London
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Please use a persistent id in citations: doi:10.1186/s12885-025-13677-0
Abstract: Surgically accessible brain metastases are treated through microsurgical removal followed by radiation therapy, resulting in improved progression-free and overall survival. Some patients experience recurrence, prompting the need for effective management strategies. Despite the prevalence of recurrence, there remains a gap in the literature regarding the outcomes of patients undergoing re-resection of brain metastases.This study aims to comprehensively characterize clinical, radiological, histopathological, and treatment-related aspects, along with outcomes, for patients undergoing re-resection of locally and distantly recurrent brain metastases.We conducted a single-center retrospective cohort study, including patients who underwent secondary brain metastasis resection following prior primary brain metastasis resection and irradiation.Among 60 patients, 41 (68.3%) had local recurrences, and 19 (31.7%) had distant recurrences. Median intracranial progression-free survival was 7.7 months [95% CI: 6.5-11.2], time to re-resection was 11.6 months [95% CI: 9.1-15.3], and overall survival was 30.8 months [95% CI: 20.4-49.5]. Non-small cell lung cancer (NSCLC) was the most common primary tumor. Post-initial resection treatments included radiation alone (31.7%), radiation plus chemotherapy (25.0%), radiation plus targeted therapy (15.0%), and radiation plus immunotherapy (28.3%). Cavity irradiation was performed in 46 patients (76.7%) and whole brain radiation in 14 (23.3%). Post-re-resection treatments varied: 21 patients (35.0%) received best supportive care, 15 (25.0%) radiation only, 12 (20.0%) systemic therapy only, and 12 (20.0%) both radiation and systemic therapy. Independent risk factors for shorter overall survival included non-breast cancer histology, pre-re-resection tumor volume > 9 mL, pre-re-resection Karnofsky Performance Status ≤ 60%, and presence of vital tumor cells at re-resection.Brain metastasis resection of local and distant recurrences is feasible and a treatment option for selected patients with good clinical performance status. This study underscores the potential role of re-resection in brain metastasis. Further research to improve patient selection and treatment algorithms is warranted.
Keyword(s): Humans (MeSH) ; Brain Neoplasms: secondary (MeSH) ; Brain Neoplasms: surgery (MeSH) ; Brain Neoplasms: mortality (MeSH) ; Female (MeSH) ; Male (MeSH) ; Middle Aged (MeSH) ; Aged (MeSH) ; Retrospective Studies (MeSH) ; Neoplasm Recurrence, Local: surgery (MeSH) ; Neoplasm Recurrence, Local: pathology (MeSH) ; Adult (MeSH) ; Reoperation (MeSH) ; Treatment Outcome (MeSH) ; Lung Neoplasms: pathology (MeSH) ; Aged, 80 and over (MeSH) ; Carcinoma, Non-Small-Cell Lung: pathology (MeSH) ; Brain metastasis ; Breast cancer ; Lung cancer ; Melanoma ; Radiotherapy ; Re-resection ; Resection ; Survival
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