Development and Validation of the Dominant Lesion Surgery Score for Brain Metastasis Resection

Overview

This 20-year single-center retrospective study developed and validated the Dominant Lesion Surgery Score (DLSS) to stratify perioperative risk following surgical resection of brain metastases. The study found that intracranial lesion number alone is insufficient for risk assessment and that integrating surgical and tumor biology factors improves prediction of early postoperative mortality.

Background

Brain metastases are the most common intracranial tumors in adults and cause significant neurological morbidity. Advances in stereotactic radiosurgery and systemic therapies have shifted treatment paradigms towards individualized, multidisciplinary approaches. Surgical resection remains important for dominant symptomatic lesions or life-threatening mass effect, but existing prognostic models do not adequately address perioperative risk after surgery.

Data Highlights

Key Findings

• Intracranial lesion count alone does not reliably predict survival after surgical resection in the current multimodal treatment era.
• Extent of resection (gross total vs subtotal) and tumor biological aggressiveness significantly influence postoperative outcomes.
• The Dominant Lesion Surgery Score (DLSS) was developed to integrate clinical, surgical, and tumor factors for perioperative risk stratification.
• DLSS demonstrated good discrimination, calibration, and clinical utility in predicting early postoperative mortality.
• Surgical resection remains a valuable option for dominant symptomatic lesions even in the presence of multiple metastases when integrated into multidisciplinary care.

Clinical Implications

Clinicians should consider factors beyond lesion count, including tumor biology and extent of resection, when selecting patients for brain metastasis surgery. The DLSS provides a practical tool to estimate perioperative risk and guide surgical decision-making within a multidisciplinary framework. This approach supports personalized treatment planning to optimize outcomes.

Conclusion

The DLSS offers a validated, quantitative framework for perioperative risk assessment following dominant lesion resection in brain metastasis patients. Incorporating surgical and biological variables enhances prognostication beyond traditional lesion count metrics.

References

1. Patchell et al. 1990 -- A Randomized Trial of Surgery in the Treatment of Single Brain Metastases
2. Soffietti et al. 2013 -- Guidelines on Management of Brain Metastases