Brain metastases: a survey of the surgical treatment of 240 patients

We report a series of 240 patients with single brain metastases operated on between 1976 and 1993, The finding of a unique metastatic brain tumor on CT or MR and the absence of other metastases elsewhere in the body were the main selection criteria for surgery. The preoperative diagnostic protocol included nuclear magnetic resonance of the brain with paramagnetic contrast, total body CT and bone scan. The analysis of the survival times of our series showed a significantly longer survival in patients treated by surgery and irradiation with respect to the non irradiated cases; and in patients with lung cancer and unknown primary tumors with respect to patients with other tumors, particularly melanoma, Recurrence and regrowth of the brain metastasis after craniotomy occurred in 39 cases; they were less frequent in patients who received postoperative irradiation with respect to the non irradiated cases (12% compared with 20% of recurrence and 35% compared with 66% of regrowth), 25 of these patients were treated by radiosurgery, The data from our study suggest an aggressive surgical approach to patients with single and solitary brain metastases and emphasize the role of postoperative whole-brain irradiation in improving the survival times and reducing the rate of recurrence.