Development of a Patient Selection Algorithm for Surgical Resection in Brain Oligometastases

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ID: 331722
2026
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Abstract
Abstract Background The incidence of brain oligometastases has increased in this era of improved systemic and targeted therapies. While there are guidelines on when resection is indicated for a single metastasis, it is unclear which patients with multiple metastases will benefit from surgery. This study aimed to develop an algorithm that identifies patients with brain oligometastases who may benefit from resection. Methods Consecutive patients with brain oligometastases, defined as 2-5 metastases, who underwent resection of a dominant lesion were retrospectively identified. Multivariable Cox regression identified independent predictors of overall survival (OS). Recursive partitioning analysis ranked predictors by prognostic importance and created a decision tree for risk-stratification. Kaplan-Meier analysis compared survival across risk groups. Results A total of 225 patients were identified. Gross-total resection (GTR) (HR = 0.56, p=0.007), postoperative radiotherapy (HR = 0.50, p<0.001), targeted inhibitor (HR = 0.48, p=0.002), and checkpoint inhibitor therapy (HR = 0.44, p=0.001) were independently associated with longer survival. Four risk groups were identified. The risk groups with the shortest OS were patients with subtotal resection regardless of adjuvant treatment and patients with GTR but no adjuvant treatment. The risk groups with the longest OS were patients who received GTR and systemic treatment and/or radiotherapy. The optimal systemic treatment varied depending on the primary cancer, with checkpoint inhibitors being most important for melanoma and targeted inhibitors being most important for breast, renal cell, and gastrointestinal carcinoma. Conclusions Resection of brain oligometastases can be associated with good long-term outcomes similar to patients with a single lesion. Achieving GTR and receiving cancer-specific adjuvant treatments are essential to good surgical outcomes.
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Authors Jiashu Chen, Poojan Shukla, Zain Peeran, Nadeem Al-Adli, Minh P. Nguyen, Austin Lui, Tony Catalan, Robert C. Osorio, Alexander F. Haddad, Steve Braunstein, Mitchel S. Berger, Philip V. Theodosopoulos, Shawn L. Hervey‐Jumper, Manish K Aghi, Jacob S. Young, Harish Vasudevan, Ramin Morshed
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Journal Neuro-Oncology Practice
Year 2026
DOI
10.1093/nop/npag099
URL
https://doi.org/10.1093/nop/npag099
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