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Abstract
Nowadays guidelines and tactics for the treatment of solid cerebral metastases have physiological and pathogenetic grounds. But the choice of treatment for cystic cerebral metastases seems not so clear. This makes it necessary to introduce evidence-based hybrid technologies for the treatment of cystic cerebral metastases into clinical practice.
Aim. To study the possibility of treatment of cystic cerebral metastases of breast cancer using hybrid surgical technologies. We have treated 162 patients with breast metastases to the brain. The study included 15 women aged 32 to 73 years. Depending on the volume and ratio of the cystic and solid components, the following method was used: in the case when we understood that after the removal of the fluid, the volume of the solid component would be 10 cm3 or less, the first stage was stereotaxic aspiration and then radiosurgical treatment (SRS). If the expected residual volume of the solid part after the supposed aspiration of the cyst was more than 10 cm3, the tumor was resected and further SRS was performed. When the total volume of metastases was not more than 10 cm3, only stereotactic irradiation was used.
Results. The number of patients with cystic neoplasms (n=15) among all patients with cerebral metastases of breast cancer (n=162) was 9.3%. The average tumor volume before treatment was 27.5 cm3 (Q1 17.8; Q3 37.4), after treatment 8.3 cm3 (Q1 7.05; Q3 10.35). 3 (20%) patients underwent only SRS, in 8 cases (53.3%) aspiration followed by SRS was performed, 4 patients (26.7%) underwent microsurgical resection followed by SRS of the tumor. In the SRS group, the mean tumor volume was reduced from 9.3 cm3 to 3.7 cm3 (2,3;4,6 cm3), in the drainage and SRS group from 37.5 cm3 to 8.2 cm3 (1,9;12,1 cm3), in the microsurgery group followed by SRS from 21.1 cm3 to 4.9 cm3 (1,8;7,1 cm3).
Conclusion. We did not find significant differences in long-term results between the study groups. The use of hybrid surgical technologies and differentiated tactics of their choice can ensure the achievement of an acceptable quality of life in conditions of high autonomy.
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