To assess the efficacy of surgical resection of brain metastases from extracranial primary cancer, we randomly assigned patients with a single brain metastasis to either surgical removal of the brain tumor followed by radiotherapy (surgical group) or needle biopsy and radiotherapy (radiation group). Forty-eight patients (25 in the surgical group and 23 in the radiation group) formed the study group; 6 other patients (11 percent) were excluded from the study because on biopsy their lesions proved to be either second primary tumors or inflammatory or infectious processes. Recurrence at the site of the original metastasis was less frequent in the surgical group than in the radiation group (5 of 25 [20 percent] vs. 12 of 23 [52 percent]; P less than 0.02). The overall length of survival was significantly longer in the surgical group (median, 40 weeks vs. 15 weeks in the radiation group; P less than 0.01), and the patients treated with surgery remained functionally independent longer (median, 38 weeks vs. 8 weeks in the radiation group; P less than 0.005). We conclude that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.
Source Information
Department of Surgery (Neurosurgery Division), University of Kentucky Medical Center, Lexington 40536-0084.
This article has been cited by other articles:
Testori, A., Rutkowski, P., Marsden, J., Bastholt, L., Chiarion-Sileni, V., Hauschild, A., Eggermont, A. M. M.
(2009). Surgery and radiotherapy in the treatment of cutaneous melanoma. Ann Oncol
20: vi22-vi29
[Abstract][Full Text]
Matsumoto, K., Ando, M., Yamauchi, C., Egawa, C., Hamamoto, Y., Kataoka, M., Shuto, T., Karasawa, K., Kurosumi, M., Kan, N., Mitsumori, M.
(2009). Questionnaire Survey of Treatment Choice for Breast Cancer Patients with Brain Metastasis in Japan: Results of a Nationwide Survey by the Task Force of the Japanese Breast Cancer Society. Jpn J Clin Oncol
39: 22-26
[Abstract][Full Text]
Schiff, D., Cavaliere, R.
(2009). Role of Fractionated Radiotherapy and Radiosurgery in Newly Diagnosed Brain Metastases. Am Soc Clin Oncol Ed Book
2009: 95-99
[Abstract][Full Text]
Buckner, J. C., Brown, P. D., O'Neill, B. P., Meyer, F. B., Wetmore, C. J., Uhm, J. H.
(2007). Central Nervous System Tumors. Mayo Clin Proc.
82: 1271-1286
[Abstract][Full Text]
Chen, W.
(2007). Clinical Applications of PET in Brain Tumors. JNM
48: 1468-1481
[Abstract][Full Text]
Silvestri, G. A., Gould, M. K., Margolis, M. L., Tanoue, L. T., McCrory, D., Toloza, E., Detterbeck, F.
(2007). Noninvasive Staging of Non-small Cell Lung Cancer: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition). Chest
132: 178S-201S
[Abstract][Full Text]
Kvale, P. A., Selecky, P. A., Prakash, U. B. S.
(2007). Palliative Care in Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest
132: 368S-403S
[Abstract][Full Text]
Eichler, A. F., Loeffler, J. S.
(2007). Multidisciplinary Management of Brain Metastases. The Oncologist
12: 884-898
[Abstract][Full Text]
Ewend, M. G., Brem, S., Gilbert, M., Goodkin, R., Penar, P. L., Varia, M., Cush, S., Carey, L. A.
(2007). Treatment of Single Brain Metastasis with Resection, Intracavity Carmustine Polymer Wafers, and Radiation Therapy Is Safe and Provides Excellent Local Control. Clin. Cancer Res.
13: 3637-3641
[Abstract][Full Text]
Singh, G., Rees, J. H, Sander, J. W
(2007). Seizures and epilepsy in oncological practice: causes, course, mechanisms and treatment. J. Neurol. Neurosurg. Psychiatry
78: 342-349
[Abstract][Full Text]
Patel, R. R., Mehta, M. P.
(2007). Targeted Therapy for Brain Metastases: Improving the Therapeutic Ratio. Clin. Cancer Res.
13: 1675-1683
[Abstract][Full Text]
Munoz, A., Lopez-Vivanco, G., Mane, J.-M., Fernandez, R., Diaz-Aguirregoitia, J., Saiz, M., Barcelo, R.
(2006). Metastatic Non-Small-Cell Lung Carcinoma Successfully Treated with Pre-operative Chemotherapy and Bilateral Adrenalectomy. Jpn J Clin Oncol
36: 731-734
[Abstract][Full Text]
Aoyama, H., Shirato, H., Tago, M., Nakagawa, K., Toyoda, T., Hatano, K., Kenjyo, M., Oya, N., Hirota, S., Shioura, H., Kunieda, E., Inomata, T., Hayakawa, K., Katoh, N., Kobashi, G.
(2006). Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.. JAMA
295: 2483-2491
[Abstract][Full Text]
Raizer, J.
(2006). Radiosurgery and whole-brain radiation therapy for brain metastases: either or both as the optimal treatment.. JAMA
295: 2535-2536
[Full Text]
Pestalozzi, B. C., Zahrieh, D., Price, K. N., Holmberg, S. B., Lindtner, J., Collins, J., Crivellari, D., Fey, M. F., Murray, E., Pagani, O., Simoncini, E., Castiglione-Gertsch, M., Gelber, R. D., Coates, A. S., Goldhirsch, A., For the International Breast Cancer Study Group,
(2006). Identifying breast cancer patients at risk for Central Nervous System (CNS) metastases in trials of the International Breast Cancer Study Group (IBCSG). Ann Oncol
17: 935-944
[Abstract][Full Text]
Vogelbaum, M. A., Suh, J. H.
(2006). Resectable Brain Metastases. JCO
24: 1289-1294
[Abstract][Full Text]
Pectasides, D., Pectasides, M., Economopoulos, T.
(2006). Brain metastases from epithelial ovarian cancer: a review of the literature.. The Oncologist
11: 252-260
[Abstract][Full Text]
Suh, J. H., Stea, B., Nabid, A., Kresl, J. J., Fortin, A., Mercier, J.-P., Senzer, N., Chang, E. L., Boyd, A. P., Cagnoni, P. J., Shaw, E.
(2006). Phase III Study of Efaproxiral As an Adjunct to Whole-Brain Radiation Therapy for Brain Metastases. JCO
24: 106-114
[Abstract][Full Text]
Gupta, T.
(2005). Stereotactic radiosurgery for brain oligometastases: good for some, better for all?. Ann Oncol
16: 1749-1754
[Abstract][Full Text]
Weil, R. J., Palmieri, D. C., Bronder, J. L., Stark, A. M., Steeg, P. S.
(2005). Breast Cancer Metastasis to the Central Nervous System. Am. J. Pathol.
167: 913-920
[Abstract][Full Text]
Langer, C. J., Mehta, M. P.
(2005). Current Management of Brain Metastases, With a Focus on Systemic Options. JCO
23: 6207-6219
[Abstract][Full Text]
Mercier, O., Fadel, E., de Perrot, M., Mussot, S., Stella, F., Chapelier, A., Dartevelle, P.
(2005). Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer. J. Thorac. Cardiovasc. Surg.
130: 136-140
[Abstract][Full Text]
Pease, N J, Edwards, A, Moss, L J
(2005). Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review. Palliat Med
19: 288-299
[Abstract]
Weil, R. J., Lonser, R. R.
(2005). Selective Excision of Metastatic Brain Tumors Originating in the Motor Cortex With Preservation of Function. JCO
23: 1209-1217
[Abstract][Full Text]
Lin, N. U., Bellon, J. R., Winer, E. P.
(2004). CNS Metastases in Breast Cancer. JCO
22: 3608-3617
[Abstract][Full Text]
Barnholtz-Sloan, J. S., Sloan, A. E., Davis, F. G., Vigneau, F. D., Lai, P., Sawaya, R. E.
(2004). Incidence Proportions of Brain Metastases in Patients Diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. JCO
22: 2865-2872
[Abstract][Full Text]
Getman, V., Devyatko, E., Dunkler, D., Eckersberger, F., End, A., Klepetko, W., Marta, G., Mueller, M. R.
(2004). Prognosis of patients with non-small cell lung cancer with isolated brain metastases undergoing combined surgical treatment. Eur. J. Cardiothorac. Surg.
25: 1107-1113
[Abstract][Full Text]
Detterbeck, F. C., Falen, S., Rivera, M. P., Halle, J. S., Socinski, M. A.
(2004). Seeking a Home for a PET, Part 2: Defining the Appropriate Place for Positron Emission Tomography Imaging in the Staging of Patients With Suspected Lung Cancer. Chest
125: 2300-2308
[Abstract][Full Text]
Grant, R
(2004). Overview: brain tumour diagnosis and management/Royal College of Physicians guidelines. J. Neurol. Neurosurg. Psychiatry
75: ii18-ii23
[Full Text]
Gerrard, G E, Franks, K N
(2004). Overview of the diagnosis and management of brain, spine, and meningeal metastases. J. Neurol. Neurosurg. Psychiatry
75: ii37-ii42
[Full Text]
Fife, K.M., Colman, M.H., Stevens, G.N., Firth, I.C., Moon, D., Shannon, K.F., Harman, R., Petersen-Schaefer, K., Zacest, A.C., Besser, M., Milton, G.W., McCarthy, W.H., Thompson, J.F.
(2004). Determinants of Outcome in Melanoma Patients With Cerebral Metastases. JCO
22: 1293-1300
[Abstract][Full Text]
Wong, E. T., Berkenblit, A.
(2004). The Role of Topotecan in the Treatment of Brain Metastases. The Oncologist
9: 68-79
[Abstract][Full Text]
Spira, A., Ettinger, D. S.
(2004). Multidisciplinary Management of Lung Cancer. NEJM
350: 379-392
[Full Text]
McWilliams, R. R., Brown, P. D., Buckner, J. C., Link, M. J., Markovic, S. N.
(2003). Treatment of Brain Metastases From Melanoma. Mayo Clin Proc.
78: 1529-1536
[Abstract]
Brown, P. D., Wald, J. T., McDermott, M. W., Baumann, G. S., Cloughesy, T. F.
(2003). Oncodiagnosis panel: 2002. Optic nerve glioma or optic nerve meningioma.. RadioGraphics
23: 1591-1611
[Full Text]
Chang, E. L., Lo, S.
(2003). Diagnosis and Management of Central Nervous System Metastases from Breast Cancer. The Oncologist
8: 398-410
[Abstract][Full Text]
Essig, M., Waschkies, M., Wenz, F., Debus, J., Hentrich, H. R., Knopp, M. V.
(2003). Assessment of Brain Metastases with Dynamic Susceptibility-weighted Contrast-enhanced MR Imaging: Initial Results. Radiology
228: 193-199
[Abstract][Full Text]
Kvale, P. A., Simoff, M., Prakash, U. B. S.
(2003). Palliative Care. Chest
123
: 284S-311S
[Abstract][Full Text]
Spiro, S. G., Porter, J. C.
(2002). Lung Cancer--Where Are We Today?: Current Advances in Staging and Nonsurgical Treatment. Am. J. Respir. Crit. Care Med.
166: 1166-1196
[Abstract][Full Text]
Antonadou, D., Paraskevaidis, M., Sarris, G., Coliarakis, N., Economou, I., Karageorgis, P., Throuvalas, N.
(2002). Phase II Randomized Trial of Temozolomide and Concurrent Radiotherapy in Patients With Brain Metastases. JCO
20: 3644-3650
[Abstract][Full Text]
Moazami, N., Rice, T. W., Rybicki, L. A., Adelstein, D. J., Murthy, S. C., DeCamp, M. M., Barnett, G. H., Chidel, M. A., Suh, J. H., Blackstone, E. H.
(2002). Stage III non-small cell lung cancer and metachronous brain metastases. J. Thorac. Cardiovasc. Surg.
124: 113-122
[Abstract][Full Text]
D'Amico, T. A., Aloia, T. A., Moore, M.-B. H., Conlon, D. H., Herndon, J. E. II, Kinch, M. S., Harpole, D. H. Jr
(2001). Predicting the sites of metastases from lung cancer using molecular biologic markers. Ann. Thorac. Surg.
72: 1144-1148
[Abstract][Full Text]
Billing, P. S., Miller, D. L., Allen, M. S., Deschamps, C., Trastek, V. F., Pairolero, P. C.
(2001). Surgical treatment of primary lung cancer with synchronous brain metastases. J. Thorac. Cardiovasc. Surg.
122: 548-553
[Abstract][Full Text]
Magne, N, Marcie, S, Pignol, J-P, Casagrande, F, Lagrange, J-L
(2001). Radiotherapy for a solitary brain metastasis during pregnancy: a method for reducing fetal dose. Br. J. Radiol.
74: 638-641
[Abstract][Full Text]
Bonnette, P., Puyo, P., Gabriel, C., Giudicelli, R., Regnard, J.-F., Riquet, M., Brichon, P.-Y.
(2001). Surgical Management of Non-small Cell Lung Cancer With Synchronous Brain Metastases. Chest
119: 1469-1475
[Abstract][Full Text]
Porte, H., Siat, J., Guibert, B., Lepimpec-Barthes, F., Jancovici, R., Bernard, A., Foucart, A., Wurtz, A.
(2001). Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann. Thorac. Surg.
71: 981-985
[Abstract][Full Text]
Arnold, S. M., Young, A. B., Munn, R. K., Patchell, R. A., Nanayakkara, N., Markesbery, W. R.
(1999). Expression of p53, bcl-2, E-Cadherin, Matrix Metalloproteinase-9, and Tissue Inhibitor of Metalloproteinases-1 in Paired Primary Tumors and Brain Metastasis. Clin. Cancer Res.
5: 4028-4033
[Abstract][Full Text]
Pearson, F. G.
(1999). Non-small Cell Lung Cancer* : Role of Surgery for Stages I-III. Chest
116
: 500S-503S
[Abstract][Full Text]
Stuschke, M., Eberhardt, W., Pottgen, C., Stamatis, G., Wilke, H., Stuben, G., Stoblen, F., Wilhelm, H. H., Menker, H., Teschler, H., Muller, R.-D., Budach, V., Seeber, S., Sack, H.
(1999). Prophylactic Cranial Irradiation in Locally Advanced Non-Small-Cell Lung Cancer After Multimodality Treatment: Long-Term Follow-Up and Investigations of Late Neuropsychologic Effects. JCO
17: 2700-2700
[Abstract][Full Text]
IV, F. E., Ryu, J. H., Miller, G. M., Luetmer, P. H., Forstrom, L. A., Burnett, O. L., Rowland, C. M., Swensen, S. J., Midthun, D. E.
(1999). Suspected Non–Small Cell Lung Cancer: Incidence of Occult Brain and Skeletal Metastases and Effectiveness of Imaging for Detection—Pilot Study. Radiology
211: 137-145
[Abstract][Full Text]
Patchell, R. A., Tibbs, P. A., Regine, W. F., Dempsey, R. J., Mohiuddin, M., Kryscio, R. J., Markesbery, W. R., Foon, K. A., Young, B.
(1998). Postoperative Radiotherapy in the Treatment of Single Metastases to the Brain: A Randomized Trial. JAMA
280: 1485-1489
[Abstract][Full Text]
Mintz, A. P., Cairncross, J. G.
(1998). Treatment of a Single Brain Metastasis: The Role of Radiation Following Surgical Resection. JAMA
280: 1527-1529
[Full Text]
Chiu, A. C., Delpassand, E. S., Sherman, S. I.
(1997). Prognosis and Treatment of Brain Metastases in Thyroid Carcinoma. J. Clin. Endocrinol. Metab.
82: 3637-3642
[Abstract][Full Text]
(1997). Pretreatment Evaluation of Non-Small-cell Lung Cancer. Am. J. Respir. Crit. Care Med.
156: 320-332
[Full Text]
Luketich, J. D., Burt, M. E.
(1996). Does Resection of Adrenal Metastases From Non-Small Cell Lung Cancer Improve Survival?. Ann. Thorac. Surg.
62: 1614-1616
[Abstract][Full Text]
Mussi, A., Pistolesi, M., Lucchi, M., Janni, A., Chella, A., Parenti, G., Rossi, G., Angeletti, C. A.
(1996). RESECTION OF SINGLE BRAIN METASTASIS IN NON-SMALL-CELL LUNG CANCER: PROGNOSTIC FACTORS. J. Thorac. Cardiovasc. Surg.
112: 146-153
[Abstract][Full Text]
Luketich, J. D., Martini, N., Ginsberg, R. J., Rigberg, D., Burt, M. E.
(1995). Successful Treatment of Solitary Extracranial Metastases From Non-Small Cell Lung Cancer. Ann. Thorac. Surg.
60: 1609-1611
[Abstract][Full Text]
Arriaga, M. A., Lo, W. W. M., Brackmann, D. E.
(1995). Metastatic Melanoma to the Cerebellopontine Angle: Clinical and Imaging Characteristics. Arch Otolaryngol Head Neck Surg
121: 1052-1056
[Abstract]
Vertosick, F. T., Henson, J. W.
(1994). Case 43-1993: Occipital Mass. NEJM
330: 793-793
[Full Text]
Mishark, K., Harrison, M., Pauker, S. G., Kopelman, R. I.
(1994). Clinical Problem-Solving: The Pursuit of Certainty. NEJM
330: 644-645
[Full Text]
Menken, M.
(1992). Practice Guidelines in Neurology Will They Get Us Where We Want To Go?. Arch Neurol
49: 193-195
[Abstract]
(1990). SURGERY BENEFICIAL IN SINGLE BRAIN METASTASES. JWatch General
1990: 1-1
[Full Text]
Previous
