BRAIN METASTASES - A SURVEY OF THE SURGICAL-TREATMENT OF 240 PATIENTS

We report a series of 240 patients with single brain metastases operat ed 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 d iagnostic protocol included nuclear magnetic resonance of the brain wi th paramagnetic contrast, total body CT and bone scan. The analysis of the survival times of our series showed a significantly longer surviv al in patients treated by surgery and irradiation with respect to the non irradiated cases; and in patients with lung cancer and unknown pri mary tumors with respect to patients with other tumors, particularly m elanoma, Recurrence and regrowth of the brain metastasis after craniot omy occurred in 39 cases; they were less frequent in patients who rece ived postoperative irradiation with respect to the non irradiated case s (12% compared with 20% of recurrence and 35% compared with 66% of re growth), 25 of these patients were treated by radiosurgery, The data f rom our study suggest an aggressive surgical approach to patients with single and solitary brain metastases and emphasize the role of postop erative whole-brain irradiation in improving the survival times and re ducing the rate of recurrence.