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Surgical
Resection for Patients with Solid Brain Metastases: Current Status
Peter M. Black, Mark D. Johnson
Brigham
and Women's Hospital, Dana-Farber-Brigham and Women's Hospital Cancer
Center, and Harvard Medical School, Boston, MA 02115, USA [P.M.B.,
M.D.J.]. E-mail: pblack@partners.org
[P.M.B.]
Brain
metastases occur in up to 40% of patients with cancer.
Their management has been revolutionized in the last decade by three
developments: improved imaging and detection of metastases, better
treatment of systemic disease with the result that metastases occur
more often; and improved surgical techniques including image-guided
surgery to treat metastatic lesions.
Class 1 data suggest that surgery is a better treatment for metastases
than whole brain radiation.
Other data suggest that metastases even in eloquent cortex can be
removed safely.
The complication rate is low and the recurrence rate is less than 10%.
In
general, indications for surgery include a mass with an unknown
primary; a symptomatic mass including one in eloquent areas; a mass
with considerable edema requiring high dose steroids; a mass greater
than 3 cm; or patient preference when radiosurgery may also be an
option.
The question of radiosurgery or whole brain radiation as adjunct to
surgical removal requires further evaluation.
Keywords: brain
metastases, brain neoplasia, brain tumors, cerebral metastases,
image-guided surgery
Copyright
©
2004 Kluwer Academic Publishers.
All rights reserved
Source: http://ipsapp007.kluweronline.com/IPS/content/ext/x/J/5042/I/124/A/8/abstract.htm
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