SURGICAL-TREATMENT OF METASTATIC BRAIN-TUMORS

The most common structural neurologic complication of systemic cancer is brain metastasis. For the most part, treatment is palliative becaus e the majority of patients (greater than or equal to 50%) have uncontr ollable systemic cancer. However, for patients in whom the only metast asis is to the brain, death is more likely to result from the metastas is than from the systemic disease; hence, treatment of the metastasis is vitally important. Although radiotherapy is generally considered th e preferred treatment, surgical removal of the mass, whether single or multiple, may be the most effective palliation, especially for tumors from radio-resistant diseases such as melanoma, kidney and colon canc er. We review the information regarding therapeutic decision-making; a dvances in surgical procedures, namely computer-assisted stereotactic and/or intraoperative ultrasound and mapping techniques; the efficacy of postoperative WBRT; complications and benefits of surgery; our expe rience with reoperation for recurrent metastatic brain tumors, the res ults of which indicate that reoperation for recurrent brain metastasis can prolong survival and improve quality of life for most individuals ; our results comparing surgery versus radiosurgery, which show that p atients who undergo surgical treatment live longer and have better tum or control than those treated with radiosurgery; and the patient's pro gnosis. The conclusion is that surgery should remain the treatment of choice whenever possible.