Neurosurgical resection and stereotactic radiation versus stereotactic radiation alone in patients with a single or solitary brain metastasis.

BACKGROUND: Brain metastases commonly manifest in cancer patients, with approximately 20-50% presenting with one intracranial lesion. Among patients with one, small brain metastasis and controlled or absent extracranial disease, it remains unclear if aggressive intracranial management utilizing neurosurgical resection and cavity stereotactic radiation (SRS/SRT) rather than SRS/SRT alone is beneficial. In patients with controlled or absent extracranial disease and one brain metastasis ≤2 cm in size, we evaluated the impact of surgery plus SRS/SRT compared to SRS/SRT on oncologic outcomes including overall survival.

METHODS: We retrospectively identified 86 patients with controlled or absent extracranial disease and one brain metastasis ≤2 cm in size treated between 2000-2015 at our institution. We examined differences in rates of local and distant failure, use of salvage treatment, and other oncologic outcomes including all-cause mortality (ACM).

RESULTS: Baseline characteristics were similar between cohorts. Median follow-up of surviving patients was 38 months. On multivariable analysis, surgical resection plus cavity SRS/SRT was associated with a lower risk of ACM (HR 0.44, 95% CI: 0.19-1.00, p=0.05) when compared to SRS/SRT alone. One and two-year rates of overall survival were 100% and 88% versus 74% and 52% for surgery plus cavity SRS/SRT versus SRS/SRT alone, respectively.

CONCLUSIONS: Aggressive, local therapy including neurosurgical resection may benefit patients with one brain metastasis in the context of controlled or absent systemic disease, even if the lesion in question is small. Further studies are needed to evaluate these associations.