gms | German Medical Science

Introduction: Brain metastases are the most frequent tumors within the brain, counting for about 40% of all cerebral lesions. Standard treatment comprises surgery, radiosurgery, and whole brain radiotherapy. Factors determining the adequate treatment are mainly depending on the KPS and age of the patient, but also on the number, size, and site of the lesions. About treatment of recurrent brain metastasis is not much known, especially whether surgical excision might be still an option. The goal of our study was to determine the prognostic factors that influence the outcome and survival of the patients together with still possible and appropriate adjuvant treatment strategies in case of recurrence.

Materials and methods: In our retrospective analysis, we evaluated all patients that have been operated on recurrent cerebral metastasis during 1993 and 2008. Included were only patients, in which the lesions were accessible without causing new neurological deficits and in which no residual tumor was left after the first operation, meaning that these patients developed a true recurrence. 67 females. The median age was 57.9 years. The most frequent primaries comprised malignant melanoma, breast-Ca and colorectal Ca, NSCLC and CUPs. The patients were evaluated with respect to age, primaries, number of lesions, interval between first operation and recurrence, adjuvant treatment, KPS pre- and postoperatively, and survival time.

Results: The median survival time of the whole group was 6.4 months. Almost half of the patients died on brain metastasis. 31% develop a second recurrence. The interval between the first operation and the re-operation influenced significantly the overall survival time, whereas number and site (distant or local) of the recurrent tumor growth did not. In 67.2% of the patients the KPS was stable or improved after surgery. WBRT after second operation was without benefit for the patients. However, WBRT after first operation prolonged significantly the recurrent-free survival.

Conclusion: In patients with recurrent brain metastases surgery is an option. Patients might profit from active treatment, especially, when prognostic factors are respected.