Surgery for Brain Metastases: Review of outcomes and focused analysis of multiple metastases and recurrent metastases following stereotactic radiosurgery

Purpose: Brain metastases require multimodal and multidisciplinary management. We have reviewed our outcomes of surgically treated brain metastases in the modern era and also performed a sub-analysis of multiple intracranial metastases and recurrent metastases resected following stereotactic radiosurgery. Methods: A single institute, retrospective, statistical analysis of patients with surgically excised brain metastases over 10 years performed at Salford Royal Hospital, Manchester, United Kingdom. Patient records accessed from the Neurooncology database and electronic records. Results: A total of 345 patients had 379 surgeries for resection of their brain metastases from January 2013 until December 2022. Mean age of the group was 59.49 ± 12.25 years. Lung (35%) and breast (19%) were the most common primaries. There were 138 patients with multiple metastases at the time of surgery, amongst which 23 underwent simultaneous resection of > 1 metastasis. There were 37 patients post-SRS who had surgery for an enlarging lesion. Mean overall survival (OS) was 31.083 months with a 2-year OS of 30.63% whereas mean progression free survival (PFS) was 22.33 months. Adjuvant therapy was the common statistically significant factor for both OS and PFS while redo surgery for OS and age for PFS was an additional significant parameter. Amongst surgically treated patients, ones receiving preoperative SRS and any adjuvant therapy had statistically significant longer OS (39 months) and PFS (20 months). Conclusions: Multimodal approach encompassing surgical resection either at diagnosis or revisional for recurrence post SRS/surgery, offers the best survival and progression-free outcomes. Surgery alleviates neurological manifestations and improves patient compliance for adjuvant therapy improving overall prognosis.