Neurological Sciences

, Volume 39, Issue 4, pp 671–677 | Cite as

Multiple brain metastases: a surgical series and neurosurgical perspective

  • Maurizio Salvati
  • Maria Pia Tropeano
  • Vincenza Maiola
  • Laura Lavalle
  • Christian Brogna
  • Claudio Colonnese
  • Alessandro Frati
  • Alessandro D’Elia
Original Article


Despite review papers claim for radical treatment of oligometastatic patients, only few surgical series have been published. In this study, we analyze results and actual role of surgical resection for the management of patients with multiple brain metastases. This retrospective study compares surgical results of two groups of patients consecutively treated in our Institute from January 2004 to June 2015. The first group comprises all 32 patients with multiple brain metastases with only 2–3 lesions who underwent surgical resection of all lesions; the second group comprises 30 patients with a single surgically treated brain mestastasis compatible with the first group (match-paired control series). Median survival was 14.6 months for patients with multiple brain metastases (range 1–28 months) and 17.4 months for patients with a single brain metastasis (range 4–38 months); the difference was not statistically significant (P = 0.2). Neurological condition improved in 59.4% of patients with multiple metastases, it remained unchanged in 37.5% and worsened in 3.1%. In our series, selected patients with only 2–3 lesions with well-controlled systemic disease, life expectancy of more than 3 months, Karnofsky’s performance status > 60, and surgically accessible lesions, benefited from surgical treatment in terms of survival and quality of life, with reduction or disappearance of significant neurological deficits. The prognosis for these patients is similar to that of patients with a single metastasis. It seems that patients with breast cancer included in our series had the worst prognosis if compared to other histotypes.


Brain metastases Oligometastases Surgery Neurosurgery RPA classes 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Walker AE, Robins M, Weinfeld FD (1985) Epidemiology of brain tumors: the national survey of intracranial neoplasms. Neurology 35(2):219–226CrossRefPubMedGoogle Scholar
  2. 2.
    Fogelholm R, Uutela T, Murros K (1984) Epidemiology of central nervous system neoplasms. A regional survey in Central Finland. Acta Neurol Scand 69(3):129–136CrossRefPubMedGoogle Scholar
  3. 3.
    American Cancer Society (2008) Cancer facts & figures 2008. American Cancer Society, AtlantaGoogle Scholar
  4. 4.
    Mintz AH, Kestle J, Rathbone MP, Gaspar L, Hugenholtz H, Fisher B, Duncan G, Skingley P, Foster G, Levine M (1996) A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 78(7):1470–1476CrossRefPubMedGoogle Scholar
  5. 5.
    Egawa S, Tukiyama I, Akine Y, Kajiura Y, Yanagawa S, Watai K, Nomura K (1986) Radiotherapy of brain metastases. Int J Radiat Oncol Biol Phys 12(9):1621–1625CrossRefPubMedGoogle Scholar
  6. 6.
    Cairncross JG, Kim JH, Posner JB (1980) Radiation therapy for brain metastases. Ann Neurol 7(6):529–541CrossRefPubMedGoogle Scholar
  7. 7.
    Sundaresan N, Galicich JH (1985) Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. Cancer 55(6):1382–1388CrossRefPubMedGoogle Scholar
  8. 8.
    White KT, Fleming TR, Laws ER Jr (1981) Single metastasis to the brain. Surgical treatment in 122 consecutive patients. Mayo Clin Proc 56(7):424–428PubMedGoogle Scholar
  9. 9.
    Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322(8):494–500CrossRefPubMedGoogle Scholar
  10. 10.
    Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JHC, Hoekstra FH, Tans JTJ, Lambooij N, Metsaars JAL, Wattendorff AR, Brand R, Hermans J (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33(6):583–590CrossRefPubMedGoogle Scholar
  11. 11.
    Kelly K, Bunn PA Jr (1998) Is it time to reevaluate our approach to the treatment of brain metastases in patients with non-small cell lung cancer? Lung Cancer 20(2):85–91CrossRefPubMedGoogle Scholar
  12. 12.
    Moazami N, Rice TW, Rybicki LA, Adelstein DJ, Murthy SC, DeCamp MM, Barnett GH, Chidel MA, Suh JH, Blackstone EH (2002) Stage III non-small cell lung cancer and metachronous brain metastases. J Thorac Cardiovasc Surg 124(1):113–122CrossRefPubMedGoogle Scholar
  13. 13.
    Nieder C, Nestle U, Motaref B, Walter K, Niewald M, Schnabel K (2000) Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis (RPA) classes? Int J Radiat Oncol Biol Phys 46(2):297–302CrossRefPubMedGoogle Scholar
  14. 14.
    Bindal RK, Sawaya R, Leavens ME, Lee JJ (1993) Surgical treatment of multiple brain metastases. J Neurosurg 79(2):210–216CrossRefPubMedGoogle Scholar
  15. 15.
    Wronski M, Arbit E et al (1997) Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer 80(9):1746–1754CrossRefPubMedGoogle Scholar
  16. 16.
    Hazuka MB, Burleson WD, Stroud DN, Leonard CE, Lillehei KO, Kinzie JJ (1993) Multiple brain metastases are associated with poor survival in patients treated with surgery and radiotherapy. J Clin Oncol 11(2):369–373CrossRefPubMedGoogle Scholar
  17. 17.
    Black P, Jhonson M (2004) Surgical resection for patients with solid brain metastases: current status. J Neuro-Oncol 69(1-3):119–124CrossRefGoogle Scholar
  18. 18.
    Modha A, Shepard S et al (2005) Surgery of brain metastases— is there still a place for it? J Neuro-Oncol 75(1):21–29CrossRefGoogle Scholar
  19. 19.
    Ranasinghe M, Sheehan J (2007) Surgical management of brain metastases. Neurosurg Focus 22(2):E2PubMedGoogle Scholar
  20. 20.
    Mut M (2012) Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg 114(1):1–8CrossRefPubMedGoogle Scholar
  21. 21.
    Hatiboglu MA, Wildrick D et al (2013) The role of surgical resection in patients with brain metastases. Ecancermedicalscience 7:308PubMedPubMedCentralGoogle Scholar
  22. 22.
    Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37(4):745–751CrossRefPubMedGoogle Scholar
  23. 23.
    Gaspar L, Scott C et al (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47(4):1001–1006CrossRefPubMedGoogle Scholar
  24. 24.
    Bindal AK, Bindal RK, Hess KR, Shiu A, Hassenbusch SJ, Shi WM, Sawaya R (1996) Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg 84(5):748–754CrossRefPubMedGoogle Scholar
  25. 25.
    Paek SH, Audu PB et al (2005) Reevaluation of surgery for the treatment of brain metastases: review of 208 patients with single or multiple brain metastases treated at one institution with modern neurosurgical techniques. Neurosurgery 56(5):1021–1034PubMedGoogle Scholar
  26. 26.
    Caroli M, Di Cristofori A, Lucarella F, Raneri FA, Portaluri F, Gaini SM (2011) Surgical brain metastases: management and outcome related to prognostic indexes: a critical review of a ten-year series. ISRN Surg 2011:207103–207108CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Schackert G, Lindner C, Petschke S, Leimert M, Kirsch M (2013) Retrospective study of 127 surgically treated patients with multiple brain metastases: indication, prognostic factors and outcome. Acta Neurochir 155(3):379–387CrossRefPubMedGoogle Scholar
  28. 28.
    Lee CH, Kim DG, Kim JW, Han JH, Kim YH, Park CK, Kim CY, Paek SH, Jung HW (2013) The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study. Acta Neurochir 155(3):389–397CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.DAI Neurology and Psychiatry, Department of Neurosurgery, Policlinico Umberto ISapienza University of RomeRomeItaly
  2. 2.Neuroscience DepartmentUniversity of SienaSienaItaly
  3. 3.Clinical Fellow NeurosurgeryKing’s College HospitalLondonUK
  4. 4.DAI Neurology and Psichiatry, Department of Neuroradiology, Policlinico Umberto ISapienza University of RomeRomeItaly
  5. 5.Neurosurgery DepartmentIRCCS NEUROMED INM, NeurochirurgiaPozzilliItaly

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