Dissecting resecting.

With advancing radiosurgery technologies and targeted systemic therapies that can penetrate the blood brain barrier, the treatment paradigm for brain mets is slowly shifting from a “resect all who can safely be resected” approach to a more multidisciplinary approach. This huge retrospective review of over 1K patients undergoing brain met resection at Brigham and Women’s Hospital aims to help clarify prognosis after a surgical approach in the modern era: 2007-2017. All the factors you’d expect to play a big role did, but maybe not in the way you’d expect. For example, sure, breast cancer primaries had the longest median survival post resection at >22 months, but the shortest median survival was among those with colorectal cancer primaries at <11 months. Otherwise, increasing number of mets (HR 1.6) and active extracranial disease (HR 1.3) portended worse survival. On the flip side, having a targetable driver mutation among mets from lung adeno (EGFR, ALK or KRAS) or from breast cancer (hormone receptor or HER2) portended better survival with the precitable exception of BRAF for melanoma not really mattering. TBL: Factors used in newer GPA models for brain mets seem to hold true with neurosurgical cases. | Kavouridis, J Neurooncol 2019