Intracerebral metastases surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Surgery is not the first-line treatment option for patients with intracerebral metastases. Surgical resection is usually reserved for patients with either a solitary brain metastasis or no extracranial spread of the primary tumor. Stereotactic radiosurgery is indicated if there are multiple (< 3) but small metastatic tumor masses.

Surgery

Surgical Resection

Surgery is not the first-line treatment option for patients with intracerebral metastases. Surgical resection is usually reserved for patients with either:

• Solitary brain metastasis
• No extracranial spread of the primary

The role of surgery in treatment of intracerebral metastases include:

• Reduction of the size of the tumor as much as possible (debulking), if the metastasis is deep or is growing into the brain tissue and causing problems
• Reduction of the intracranial pressure
• Relief from the symptoms, if a brain metastasis cannot be completely resected

Stereotactic Radiosurgery

• Stereotactic radiosurgery (SRS) delivers a single high dose of irradiation to the target volume while avoiding the surrounding normal tissues.
• This therapy aims small beams of radiation from different directions at the tissue to be treated.
• The addition of stereotactic radiosurgery to whole brain radiotherapy was superior to whole brain radiotherapy alone in patients with a newly diagnosed solitary brain lesion. A survival benefit was not observed for patients with two or three metastatic lesions, although local brain control was significantly improved with the addition of stereotactic radiosurgery. Given its focal delivery of irradiation, there have been concerns that its isolated use could lead to an increased rate of failure elsewhere in the brain. However, concerns with cognitive deficits from whole brain radiotherapy led to the usage of stereotactic radiosurgery alone in selected patients, reserving whole brain radiotherapy for a later date if necessary.
• Indications for stereotactic radiation therapy include:

• One or a few metastatic brain tumors

• Used to treat people with upto 3 small-sized metastatic brain tumors

• Alone or in combination with whole brain radiation therapy (WBRT)
• Progressive or recurrent brain metastases

• Stereotactic radiotherapy may be given after the person has had whole brain radiation therapy

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