Survival, quality of life, and motor function in brain metastases surgery: The role of complete resection

Rebecca R Winther; Marianne J Hjermstad; Olav Erich Yri; Eva Skovlund; Nina Aass; Guro L Astrup; Stein Kaasa; Cathrine Saxhaug; Einar Osland Vik-Mo

doi:10.1093/nop/npaf011

Survival, quality of life, and motor function in brain metastases surgery: The role of complete resection

Neurooncol Pract. 2025 Jan 31;12(4):644-653. doi: 10.1093/nop/npaf011. eCollection 2025 Aug.

Authors

Rebecca R Winther¹, Marianne J Hjermstad¹, Olav Erich Yri¹, Eva Skovlund², Nina Aass¹, Guro L Astrup¹, Stein Kaasa¹, Cathrine Saxhaug³, Einar Osland Vik-Mo⁴

Affiliations

¹ Department of Oncology, Oslo University Hospital, Oslo, Norway/European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
² Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
³ Division of Radiology and Nuclear Medicine, University Hospital, Oslo, Norway.
⁴ Vilhelm Magnus Laboratory, Department of Neurosurgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Abstract

Background: One in 3 patients with advanced cancer develops brain metastases. Surgical resection of brain metastases is done in 15%-20% of these patients. While gross total resection (GTR) is believed to extend overall survival (OS), concerns exist regarding increased morbidity. This study examines the impact of surgical resection, particularly GTR, on self-reported symptoms, focusing on quality of life (QoL) and motor dysfunction.

Methods: We conducted a prospective cohort study involving adult patients undergoing surgical resection for brain metastases from solid tumors in a defined region of Norway between 2017 and 2021. Clinical data were collected at inclusion prior to surgery and every 3 months the first year. Patients completed monthly questionnaires assessing QoL and motor dysfunction. QoL was measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL, while motor dysfunction was evaluated using the EORTC QLQ-BN20.

Results: A total of 155 patients were included and median OS was 13 months. GTR was achieved in 69 (44%) patients and was associated with longer median OS compared to subtotal resection (17.7 vs. 10.9 months, P = .04). Mean QoL remained stable throughout the follow-up period. Improved motor dysfunction 1 month after surgery was reported by 23% of the patients, while 25% reported worse motor dysfunction. Factors associated with a high motor dysfunction score at 1 month were age >70 years, higher baseline motor dysfunction, and multiple brain metastases. Neither GTR nor location of metastases in motor-associated areas were associated with worsened motor dysfunction.

Conclusion: Self-reported QoL is maintained after surgery for brain metastases. Complete resection is associated with extended OS without compromising self-reported motor function.

Keywords: brain metastases; postoperative motor dysfunction; quality of life; surgery.