Abstract

Objective:The influence on therapeutic outcomes of wide surgical resection of brain metastasis (BM) including tumor cells that microscopically infiltrate adjacent brain parenchyma, with clean surgical margins confirmed by intraoperative margin biopsy is not known. This study was carried out to clarify the therapeutic impact of these resections.
Methods: From June 2002 to April 2014, 90 patients (66 men and 24 women; mean age: 56.7 years) underwent surgical resection for BM. In 47 patients (group A), we undertook microscopically complete resection, including microscopic infiltrative tumor cells adjacent to the brain parenchyma, with pathologically clean surgical margins confirmed during surgery for BMs in a noneloquent area. In 43 patients (group B), we undertook gross complete resection without removal of neighboring brain parenchyma due to eloquent location. The two groups were compared for survival, and local and distant recurrence.
Results:Mean follow-up duration was 18.6 months; 71 patients (78.9%) died during follow-up. Median survival was 13.1 months in group A and 12.1 months in group B (p=0.309). One-year and two-year local recurrence were 21.2% and 25.8%, respectively, in group A, and 65.2% for both in group B (p=0.000). One-year and two-year distant recurrence rates were 46.3% and 57.2% in group A, respectively, and 33.2% for both in group B(p=0.140).
Conclusion: These results suggested that wide surgical resection of BM including tumor cells infiltrating adjacent brain parenchyma with confirmed clean surgical marginsresulted in better local control.