Brain Tumor Res Treat.  2023 Jan;11(1):1-7. 10.14791/btrt.2022.0028.

Revisiting the Role of Surgical Resection for Brain Metastasis

• Byun J
• Kim JH

• KMID: 2539323
• DOI: http://doi.org/10.14791/btrt.2022.0028

Abstract

Brain metastasis (BM) is the most common type of brain tumor in adults. The contemporary management of BM remains challenging. Advancements in systemic cancer treatment have increased the survival of patients with cancer. Although the treatment of BM is still complicated, advances in radiotherapy, including stereotactic radiosurgery and chemotherapy, have improved treatment outcomes. Surgical resection is the traditional treatment for BM and its role in the surgical resection of BM has been well established. However, refinement of the surgical resection technique and strategy for BM is needed. Herein, we discuss the evolving role of surgery in patients with BM and the future of BM treatment.

Keyword

Brain metastasis; Surgery; Outcome

Reference

1. Ahn JH, Lee SH, Kim S, Joo J, Yoo H, Lee SH, et al. Risk for leptomeningeal seeding after resection for brain metastases: implication of tumor location with mode of resection. J Neurosurg. 2012; 116:984–993. PMID: 22339161.

2. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2001; 94:2698–2705.

3. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol. 1988; 45:741–744. PMID: 3390029.

4. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005; 75:5–14. PMID: 16215811.

5. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012; 14:48–54. PMID: 22012633.

6. O’Beirn M, Benghiat H, Meade S, Heyes G, Sawlani V, Kong A, et al. The expanding role of radiosurgery for brain metastases. Medicines (Basel). 2018; 5:90. PMID: 30110927.

7. Wagner S, Lanfermann H, Wohlgemuth WA, Gufler H. Effects of effective stereotactic radiosurgery for brain metastases on the adjacent brain parenchyma. Br J Cancer. 2020; 123:54–60. PMID: 32362656.

8. Minniti G, Clarke E, Lanzetta G, Osti MF, Trasimeni G, Bozzao A, et al. Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol. 2011; 6:48. PMID: 21575163.

9. Ng PR, Choi BD, Aghi MK, Nahed BV. Surgical advances in the management of brain metastases. Neurooncol Adv. 2021; 3(Suppl 5):v4–v15. PMID: 34859228.

10. Gupta S, Dawood H, Giantini Larsen A, Fandino L, Knelson EH, Smith TR, et al. Surgical and peri-operative considerations for brain metastases. Front Oncol. 2021; 11:662943. PMID: 34026641.

11. Overcast WB, Davis KM, Ho CY, Hutchins GD, Green MA, Graner BD, et al. Advanced imaging techniques for neuro-oncologic tumor diagnosis, with an emphasis on PET-MRI imaging of malignant brain tumors. Curr Oncol Rep. 2021; 23:34. PMID: 33599882.

12. Goo HW, Ra YS. Advanced MRI for pediatric brain tumors with emphasis on clinical benefits. Korean J Radiol. 2017; 18:194–207. PMID: 28096729.

13. Verma N, Cowperthwaite MC, Burnett MG, Markey MK. Differentiating tumor recurrence from treatment necrosis: a review of neuro-oncologic imaging strategies. Neuro Oncol. 2013; 15:515–534. PMID: 23325863.

14. Costabile JD, Alaswad E, D’Souza S, Thompson JA, Ormond DR. Current applications of diffusion tensor imaging and tractography in intracranial tumor resection. Front Oncol. 2019; 9:426. PMID: 31192130.

15. Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012; 30:419–425. PMID: 22203767.

16. Ene CI, Ferguson SD. Surgical management of brain metastasis: challenges and nuances. Front Oncol. 2022; 12:847110. PMID: 35359380.

17. Masucci GL. Hypofractionated radiation therapy for large brain metastases. Front Oncol. 2018; 8:379. PMID: 30333955.

18. Kim JW, Park HR, Lee JM, Kim JW, Chung HT, Kim DG, et al. Fractionated stereotactic gamma knife radiosurgery for large brain metastases: a retrospective, single center study. PLoS One. 2016; 11:e0163304. PMID: 27661613.

19. Sankey EW, Tsvankin V, Grabowski MM, Nayar G, Batich KA, Risman A, et al. Operative and peri-operative considerations in the management of brain metastasis. Cancer Med. 2019; 8:6809–6831. PMID: 31568689.

20. Shimony N, Shofty B, Harosh CB, Sitt R, Ram Z, Grossman R. Surgical resection of cerebral metastases leads to faster resolution of peritumoral edema than stereotactic radiosurgery: a volumetric analysis. Ann Surg Oncol. 2017; 24:1392–1398. PMID: 27896517.

21. Amidei C, Kushner DS. Clinical implications of motor deficits related to brain tumors. Neurooncol Pract. 2015; 2:179–184. PMID: 31386054.

22. Schwartz C, Rautalin I, Niemelä M, Korja M. Symptomatic peritumoral edema is associated with surgical outcome: a consecutive series of 72 supratentorial meningioma patients ≥ 80 years of age. J Neurooncol. 2020; 148:109–116. PMID: 32318913.

23. Rahman M, Cox JB, Chi YY, Carter JH, Friedman WA. Radiographic response of brain metastasis after linear accelerator radiosurgery. Stereotact Funct Neurosurg. 2012; 90:69–78. PMID: 22286386.

24. Cirak M, Guclu DG, Akar E, Kazanci MH, Tural D. Retrospective analysis of survival in patients with brain metastases from an unknown primary tumor. Turk Neurosurg. 2020; 30:932–936. PMID: 33216341.

25. Polyzoidis KS, Miliaras G, Pavlidis N. Brain metastasis of unknown primary: a diagnostic and therapeutic dilemma. Cancer Treat Rev. 2005; 31:247–255. PMID: 15913895.

26. Sahgal A, Ruschin M, Ma L, Verbakel W, Larson D, Brown PD. Stereotactic radiosurgery alone for multiple brain metastases? A review of clinical and technical issues. Neuro Oncol. 2017; 19(suppl_2):ii2–ii15. PMID: 28380635.

27. Kraft J, Zindler J, Minniti G, Guckenberger M, Andratschke N. Stereotactic radiosurgery for multiple brain metastases. Curr Treat Options Neurol. 2019; 21:6. PMID: 30758726.

28. Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev. 2017; 9:CD006121. PMID: 28945270.

29. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011; 29:134–141. PMID: 21041710.

30. Mut M. Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg. 2012; 114:1–8. PMID: 22047649.

31. Sneed PK, Mendez J, Vemer-van den Hoek JG, Seymour ZA, Ma L, Molinaro AM, et al. Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg. 2015; 123:373–386. PMID: 25978710.

32. Pollock BE, Brown PD, Foote RL, Stafford SL, Schomberg PJ. Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol. 2003; 61:73–80. PMID: 12587798.

33. Salvati M, Tropeano MP, Maiola V, Lavalle L, Brogna C, Colonnese C, et al. Multiple brain metastases: a surgical series and neurosurgical perspective. Neurol Sci. 2018; 39:671–677. PMID: 29383618.

34. Matsuda R, Morimoto T, Tamamoto T, Inooka N, Ochi T, Miyasaka T, et al. Salvage surgical resection after linac-based stereotactic radiosurgery for newly diagnosed brain metastasis. Curr Oncol. 2021; 28:5255–5265. PMID: 34940078.

35. Nieder C, Yobuta R, Mannsåker B. Second re-irradiation of brain metastases: a review of studies involving stereotactic radiosurgery. Cureus. 2018; 10:e3712. PMID: 30788201.

36. Loi M, Caini S, Scoccianti S, Bonomo P, De Vries K, Francolini G, et al. Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: systematic review and meta-analysis. Crit Rev Oncol Hematol. 2020; 153:103043. PMID: 32650217.

37. Kowalchuk RO, Niranjan A, Lee CC, Yang HC, Liscak R, Guseynova K, et al. Reirradiation with stereotactic radiosurgery after local or marginal recurrence of brain metastases from previous radiosurgery. Int J Radiat Oncol Biol Phys. 2022; 112:726–734. PMID: 34644606.

38. Lalani N, Huang SH, Rotstein C, Yu E, Irish J, O’Sullivan B. Skull base or cervical vertebral osteomyelitis following chemoradiotherapy for pharyngeal carcinoma: a serious but treatable complication. Clin Transl Radiat Oncol. 2017; 8:40–44. PMID: 29594240.

39. Trojanowski P, Sojka M, Trojanowska A, Wolski A, Roman T, Jargiello T. Management of radiation induced carotid stenosis in head and neck cancer. Transl Oncol. 2019; 12:1026–1031. PMID: 31146165.

40. Habib A, Hanasono MM, DeMonte F, Haider A, Breshears JD, Nader ME, et al. Surgical management of skull base osteoradionecrosis in the cancer population–treatment outcomes and predictors of recurrence: a case series. Oper Neurosurg (Hagerstown). 2020; 19:364–374. PMID: 32324878.

41. Kotecha R, Angelov L, Barnett GH, Reddy CA, Suh JH, Murphy ES, et al. Calvarial and skull base metastases: expanding the clinical utility of gamma knife surgery. J Neurosurg. 2014; 121 Suppl:91–101.

42. Park I, Chung DH, Yoo CJ, Shin DB. Skull metastasis of gastric gastrointestinal stromal tumor successfully managed by surgery. J Korean Neurosurg Soc. 2017; 60:94–97. PMID: 28061498.

43. Chaichana KL, Flores M, Acharya S, Sampognaro P, Bettegowda C, Rigamonti D, et al. Survival and recurrence for patients undergoing surgery of skull base intracranial metastases. J Neurol Surg B Skull Base. 2013; 74:228–235. PMID: 24436917.

44. Mitsuya K, Nakasu Y, Horiguchi S, Harada H, Nishimura T, Yuen S, et al. Metastatic skull tumors: MRI features and a new conventional classification. J Neurooncol. 2011; 104:239–245. PMID: 21110218.

45. Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J, Delattre JY. Skull-base metastases. J Neurooncol. 2005; 75:63–69. PMID: 16215817.

46. Winther RR, Hjermstad MJ, Skovlund E, Aass N, Helseth E, Kaasa S, et al. Surgery for brain metastases-impact of the extent of resection. Acta Neurochir (Wien). 2022; 164:2773–2780. PMID: 35080651.

47. Yoo H, Kim YZ, Nam BH, Shin SH, Yang HS, Lee JS, et al. Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg. 2009; 110:730–736. PMID: 19072310.

48. Patel AJ, Suki D, Hatiboglu MA, Abouassi H, Shi W, Wildrick DM, et al. Factors influencing the risk of local recurrence after resection of a single brain metastasis. J Neurosurg. 2010; 113:181–189. PMID: 20035574.

49. Suki D, Hatiboglu MA, Patel AJ, Weinberg JS, Groves MD, Mahajan A, et al. Comparative risk of leptomeningeal dissemination of cancer after surgery or stereotactic radiosurgery for a single supratentorial solid tumor metastasis. Neurosurgery. 2009; 64:664–674. discussion 674-6. PMID: 19197219.

50. Patel AJ, Suki D, Hatiboglu MA, Rao VY, Fox BD, Sawaya R. Impact of surgical methodology on the complication rate and functional outcome of patients with a single brain metastasis. J Neurosurg. 2015; 122:1132–1143. PMID: 25794344.

51. Suki D, Abouassi H, Patel AJ, Sawaya R, Weinberg JS, Groves MD. Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. J Neurosurg. 2008; 108:248–257. PMID: 18240919.

52. Ha B, Chung SY, Kim YJ, Gwak HS, Chang JH, Lee SH, et al. Effects of postoperative radiotherapy on leptomeningeal carcinomatosis or dural metastasis after resection of brain metastases in breast cancer patients. Cancer Res Treat. 2017; 49:748–758. PMID: 27809457.

53. Tewarie IA, Jessurun CAC, Hulsbergen AFC, Smith TR, Mekary RA, Broekman MLD. Leptomeningeal disease in neurosurgical brain metastases patients: a systematic review and meta-analysis. Neurooncol Adv. 2021; 3:vdab162. PMID: 34859226.

54. van der Ree TC, Dippel DW, Avezaat CJ, Sillevis Smitt PA, Vecht CJ, van den Bent MJ. Leptomeningeal metastasis after surgical resection of brain metastases. J Neurol Neurosurg Psychiatry. 1999; 66:225–227. PMID: 10071105.

55. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998; 280:1485–1489. PMID: 9809728.

56. De la Garza-Ramos R, Kerezoudis P, Tamargo RJ, Brem H, Huang J, Bydon M. Surgical complications following malignant brain tumor surgery: an analysis of 2002-2011 data. Clin Neurol Neurosurg. 2016; 140:6–10. PMID: 26615463.

57. Lassen B, Helseth E, Rønning P, Scheie D, Johannesen TB, Mæhlen J, et al. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery. 2011; 68:1259–1268. discussion 1268-9. PMID: 21273920.

58. Przybylowski CJ, Whiting AC, Preul MC, Smith KA. Anatomical subpial resection of tumors in the amygdala and hippocampus. World Neurosurg. 2021; 151:e652–e662. PMID: 33940265.

59. Nakase H, Shin Y, Nakagawa I, Kimura R, Sakaki T. Clinical features of postoperative cerebral venous infarction. Acta Neurochir (Wien). 2005; 147:621–626. PMID: 15770350.

60. Liu W, Ni M, Zhang Y, Groen RJ. Antibiotic prophylaxis in craniotomy: a review. Neurosurg Rev. 2014; 37:407–414. PMID: 24526365.

61. Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017; 18:1040–1048. PMID: 28687375.

62. Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017; 18:1049–1060. PMID: 28687377.

63. Prabhu RS, Patel KR, Press RH, Soltys SG, Brown PD, Mehta MP, et al. Preoperative vs postoperative radiosurgery for resected brain metastases: a review. Neurosurgery. 2019; 84:19–29. PMID: 29771381.

64. Ginzac A, Dupic G, Brun L, Molnar I, Casile M, Durando X, et al. Preoperative stereotactic radiosurgery for brain metastases: the STEP study protocol for a multicentre, prospective, phase-II trial. BMC Cancer. 2021; 21:864. PMID: 34320940.

65. Lee HH, Chen CH, Chuang HY, Huang YW, Huang MY. Brain surgery in combination with tyrosine kinase inhibitor and whole brain radiotherapy for epidermal growth factor receptor-mutant non-small-cell lung cancer with brain metastases. Sci Rep. 2019; 9:16834. PMID: 31728013.

66. Magnuson WJ, Lester-Coll NH, Wu AJ, Yang TJ, Lockney NA, Gerber NK, et al. Management of brain metastases in tyrosine kinase inhibitor–naïve epidermal growth factor receptor–mutant non–small-cell lung cancer: a retrospective multi-institutional analysis. J Clin Oncol. 2017; 35:1070–1077. PMID: 28113019.

67. Phang I, Leach J, Leggate JRS, Karabatsou K, Coope D, D’Urso PI. Minimally invasive resection of brain metastases. World Neurosurg. 2019; 130:e362–e367. PMID: 31233927.

68. Baker CM, Glenn CA, Briggs RG, Burks JD, Smitherman AD, Conner AK, et al. Simultaneous resection of multiple metastatic brain tumors with multiple keyhole craniotomies. World Neurosurg. 2017; 106:359–367. PMID: 28652117.

69. Eroglu U, Shah K, Bozkurt M, Kahilogullari G, Yakar F, Dogan İ, et al. Supraorbital keyhole approach: lessons learned from 106 operative cases. World Neurosurg. 2019; 124:e667–e674.

70. Zacharia BE, Romero FR, Rapoport SK, Raza SM, Anand VK, Schwartz TH. Endoscopic endonasal management of metastatic lesions of the anterior skull base: case series and literature review. World Neurosurg. 2015; 84:1267–1277. PMID: 26079759.

71. Park HH, Roh TH, Choi S, Yoo J, Kim WH, Jung IH, et al. Endoscopic transorbital approach to mesial temporal lobe for intra-axial lesions: cadaveric study and case series (SevEN-008). Oper Neurosurg (Hagerstown). 2021; 21:E506–E515. PMID: 34528091.

72. Ferraro N, Barbarite E, Albert TR, Berchmans E, Shah AH, Bregy A, et al. The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review. Neurosurg Rev. 2016; 39:545–555. PMID: 26815631.

73. Ahrens LC, Krabbenhøft MG, Hansen RW, Mikic N, Pedersen CB, Poulsen FR, et al. Effect of 5-aminolevulinic acid and sodium fluorescein on the extent of resection in high-grade gliomas and brain metastasis. Cancers (Basel). 2022; 14:617. PMID: 35158885.

74. Kamp MA, Fischer I, Bühner J, Turowski B, Cornelius JF, Steiger HJ, et al. 5-ALA fluorescence of cerebral metastases and its impact for the local-in-brain progression. Oncotarget. 2016; 7:66776–66789. PMID: 27564260.

75. Kamp MA, Grosser P, Felsberg J, Slotty PJ, Steiger HJ, Reifenberger G, et al. 5-aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir (Wien). 2012; 154:223–228. PMID: 22080159.

76. Utsuki S, Miyoshi N, Oka H, Miyajima Y, Shimizu S, Suzuki S, et al. Fluorescence-guided resection of metastatic brain tumors using a 5-aminolevulinic acid-induced protoporphyrin IX: pathological study. Brain Tumor Pathol. 2007; 24:53–55. PMID: 18095131.

77. Raleigh DR, Seymour ZA, Tomlin B, Theodosopoulos PV, Berger MS, Aghi MK, et al. Resection and brain brachytherapy with permanent iodine-125 sources for brain metastasis. J Neurosurg. 2017; 126:1749–1755. PMID: 27367240.

78. Huang K, Sneed PK, Kunwar S, Kragten A, Larson DA, Berger MS, et al. Surgical resection and permanent iodine-125 brachytherapy for brain metastases. J Neurooncol. 2009; 91:83–93. PMID: 18719856.

79. Pham A, Yondorf MZ, Parashar B, Scheff RJ, Pannullo SC, Ramakrishna R, et al. Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial. J Neurooncol. 2016; 127:63–71. PMID: 26650067.