• Nayan Lamba, Daniel N Cagney, Rachel H Brigell, Allison M Martin, Luke A Besse, Paul J Catalano, John G Phillips, Itai M Pashtan, Wenya Linda Bi, Elizabeth B Claus, Alexandra J Golby, Ian F Dunn, Timothy R Smith, Shyam K Tanguturi, Daphne A Haas-Kogan, Brian M Alexander, and Ayal A Aizer.
• Harvard Medical School, Boston, Massachusetts.
• World Neurosurg. 2019 Feb 1; 122: e1557-e1561.

BackgroundBrain metastases commonly manifest in patients with cancer, with ∼20%-50% presenting with 1 intracranial lesion. Among patients with 1, small brain metastasis and controlled or absent extracranial disease, it remains unclear whether aggressive intracranial management using neurosurgical resection plus cavity stereotactic radiosurgery/stereotactic radiotherapy (SRS/SRT) rather than SRS/SRT alone is beneficial. In patients with controlled or absent extracranial disease and 1 brain metastasis ≤2 cm in size, we evaluated the effect of surgery plus SRS/SRT compared with SRS/SRT on oncologic outcomes, including overall survival.MethodsWe retrospectively identified 86 patients with controlled or absent extracranial disease and 1 brain metastasis ≤2 cm in size who had been treated from 2000 to 2015 at our institution. We examined differences in the rates of local and distant failure, use of salvage treatment, and other oncologic outcomes, including all-cause mortality.ResultsThe baseline characteristics were similar between the 2 cohorts. The median follow-up period for the surviving patients was 38 months. On multivariable analysis, surgical resection plus cavity SRS/SRT was associated with a lower risk of all-cause mortality (hazard ratio, 0.44; 95% confidence interval, 0.19-1.00; P = 0.05) compared with SRS/SRT alone. The 1- and 2-year rates of overall survival were 100% and 88% versus 74% and 52% for surgery plus cavity SRS/SRT versus SRS/SRT alone, respectively.ConclusionsAggressive, local therapy, including neurosurgical resection, might benefit patients with 1 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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