The Metastatic Brain Tumors

OBJECTIVE: To discuss the surgical indications and the role of the radiotherapy in metastatic brain tumors.
STUDY DESIGN: Hundred and twenty-three patients underwent surgical treatment due to a intracerebral tumor in Şişli Etfal Hospital, Department of Neurosurgery during last two years. Twenty of them who had metastatic brain tumor were discussed in this study. Fifteen (75%) were male and five (25%) were female. The median age at the time of the initial diagnosis of brain metastasis was 49.75. Fifteen patients were presented with only one intracranial metastasis, two with two, two with three and one with more than three.
RESULTS: Seven patients with lung metastases, three with gastrointestinal, two with breast, two with kidney, two with prostate ýwo with malignant melanoma, mýe with urinary tract and one with uterus (This rare case had ýýterine lelomyosarcoma metastasis) had the primary site of their tumor. lýý eleven patients the systemic caný.: er was estcýblis­ hed after diagnosing the intracerebral metastasis. Preoperative radiotherapy was applied to none of the patients. All patients were treated with surgery. The aim ol the surgical treatment was to remove the life threatening lesion or lesion that deteriorates the patients neurological status. The presence of a tumor in the posterior fossa was a certain in­dication. Median survival time after the operation was 7.5 months. Postoperative radiotherapy was performed to 10 of 20 patients.
CONCLUSİON: The life-threatening lesions, lesions which deteriorate the patients neurological status, and all lesions which are easy to remove should he operated. There is no significant dfference between the median survival time of the patients treated with and without postoperative radioterapy in this study.

Metastik Beyin Tümörlerine Yaklaşým

AMAÇ: Metastatik beyin tümörlerinde cerrahi tedavi endikasymýlarýnýn ve radyoterapinin rolünün tartýşýlmasý.
MATERYAL VE METOD: Son iki yýl içinde Şişli Etfal Hastanesi Beyin ve Sinir Cerrahisi Kliniğine 123 olgu intraserebral tümör nedeni ile opere edildi. Bu çalýşmada metastatik tümörü olan 20 olgu tartýşýldý. Onbeş olgu (%75) erkek ve beş olgu (%25) ise kadýn idi. Beyin metastazýnýn tesbit edildiği ortalama yaş 49.75 idi. Onbeş olguda sadece tek lezyon, ikisinde iki, ikisinde üç ve de birinde üçten fazla lezyon saptandý.
BULGULAR: Beyin metastazlarýnýn primer odağa göre daðýlýmý şöyle idi: Akciğer (7), Gastrointestinal Sistem (GİS) (3), Meme (2), Böbrek (2), Prostat (2), Malign Melanom (2), Üriner yollar (1), Uterus (1). Uterus leyomiyosarkom metastazýnýn beyinde son derece nadir görülmesi nedeni ile, bu olgu ayrýca vurgulandý. Onbir olguda, intraserehral metastaz teşhis edildikten sonra primer odak ortaya çýkartýlabildi. Hiçbir olguya preoperatif radyoterapi uygulanmadý. Tüm olgular opere edildi. Cerrahi tedavinin amaýcý öncelikle hayatý tehdit eden ve nörolojik tabloyu bozan lezyona müdahale etmek idi. Lezyonun arka çukurda olmasý kesin endikasyon olarak kabul edildi. Operasyon sonrasý ortalama yaşam süresi 7.5 ay olarak teshil edildi. Postoperatif radyoterapi yirmi olgudan on tanesine uygulandý.
SONUÇ: Hayatý tehdit eden, nörolojik tabloyu bozan ve çýkarýlmasý kolay olan tüm lezyonlar opere edilmelidir. Bu çalýşmada, ortalama yaşam süresi açýsýndan postoperatif radyoterapi uygulanan ve uygulanmayan olgular arasýnda anlamlý bir fark tesbit edilmedi.