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@ARTICLE{Wasilewski:301748,
      author       = {D. Wasilewski$^*$ and Z. Shaked and A. Fuchs and S.
                      Roohani$^*$ and R. Xu and M. Schlaak$^*$ and N. Frost$^*$
                      and M. Misch and D. Capper$^*$ and D. Kaul$^*$ and J.
                      Onken$^*$ and P. Vajkoczy and F. Ehret$^*$},
      title        = {{R}e-resection of brain metastases - outcomes of an
                      institutional cohort study and literature review.},
      journal      = {BMC cancer},
      volume       = {25},
      number       = {1},
      issn         = {1471-2407},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2025-01132},
      pages        = {973},
      year         = {2025},
      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.},
      subtyp        = {Review Article},
      keywords     = {Humans / Brain Neoplasms: secondary / Brain Neoplasms:
                      surgery / Brain Neoplasms: mortality / Female / Male /
                      Middle Aged / Aged / Retrospective Studies / Neoplasm
                      Recurrence, Local: surgery / Neoplasm Recurrence, Local:
                      pathology / Adult / Reoperation / Treatment Outcome / Lung
                      Neoplasms: pathology / Aged, 80 and over / Carcinoma,
                      Non-Small-Cell Lung: pathology / Brain metastasis (Other) /
                      Breast cancer (Other) / Lung cancer (Other) / Melanoma
                      (Other) / Radiotherapy (Other) / Re-resection (Other) /
                      Resection (Other) / Survival (Other)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40452031},
      doi          = {10.1186/s12885-025-13677-0},
      url          = {https://inrepo02.dkfz.de/record/301748},
}