Author(s): Zakaria R.; Jenkinson M.; Rudland P.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 114
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Brain metastases (BM) have recently been found to have different patterns of growth and invasion, hence supramargi-nal resection or cavity radiosurgery are proposed as means of improving local control. We investigated growth and surgical approaches to resection in the two most common BM types, lung and breast cancer. Methods: Retrospective review of 43 breast cancer and 55 non-small cell lung cancer BM operated over a 5 year period with attention to surgical approach as recorded in the operating notes-gross total, en bloc resection vs. piecemeal resection. Prospective samples taken from the leading edge of 4 breast cancer and 13 lung cancer metastases in the course of a separate research study were re-analysed for growth pattern and evidence of microscopic invasion. Results: Cases with a complete en bloc resection showed a trend to longer overall survival, 11 vs. 3 months for breast cancer BMs (log rank 2.23, p=0.135) and 7 vs. 2 months for non-small cell lung BMs (log rank 3.68, p= 0.055). All 4 breast cancer BM and 11/13 lung cancer BM showed a more locally invasive, non-encapsulated growth pattern microscopically and this was not accurately predicted by the operating neurosurgeon. It was noted that the pattern of growth at the leading edge was heterogeneous within single large BMs. Conclusions: Strategies to increase local control of BMs do have a biological basis but there may be significant intra-and inter-tumoral heterogeneity and biomarkers will be needed to assist the operating surgeon.