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Although surgical resection is part of multimodal management, the prognostic relevance of surgical intracranial tumor load reduction in the era of stereotactic radiotherapy and modern systemic therapies remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective bicentric cohort study included 285 adults with histologically confirmed NSCLC who underwent BM resection. Pre- and postoperative MRI were used for volumetric assessment. Gross-total resection (GTR) was defined as the absence of measurable postoperative residual volume (RV). Outcomes were overall survival (OS) and intracranial progression-free survival (iPFS). Multivariable Cox regression models adjusted for age, preoperative performance status, extracranial metastases, number of BM, and postoperative radiotherapy and systemic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median OS was 14.3 months and median iPFS was 8.0 months. GTR was achieved in 96 patients (34% overall; 38% of patients with evaluable volumetric imaging) and was independently associated with longer OS (adjusted HR, 0.51; 95% CI, 0.30\u20130.86) and prolonged iPFS (adjusted HR, 0.55; 95% CI, 0.31\u20130.99). Postoperative RV, analyzed continuously or categorically, showed no consistent association with OS or iPFS. The benefit of GTR was most pronounced in patients with single BM or without extracranial metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Achieving complete intracranial tumor resection, rather than the amount of postoperative residual volume, was consistently associated with improved survival and intracranial disease control. These findings support the clinical relevance of GTR in selected NSCLC-BM patients and may inform patient counselling and surgical decision-making, while warranting further investigation in patients with multifocal but safely resectable intracranial disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-025-05387-1","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T16:04:37Z","timestamp":1766419477000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Postoperative absence of residual intracranial tumor volume is associated with improved survival and intracranial disease control in non-small cell lung cancer brain metastases"],"prefix":"10.1007","volume":"176","author":[{"given":"Jacopo","family":"Bellomo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meltem","family":"G\u00f6nel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Sutter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Zeitlberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Nikolaeva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"Schmidlechner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Stumpo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Padevit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Egon","family":"Staartjes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Vasella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorn","family":"Fierstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolin","family":"Hainc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Opitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Weller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Le Rhun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Bozinov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Regli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Serra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian Christoph","family":"Neidert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1514-1442","authenticated-orcid":false,"given":"Stefanos","family":"Voglis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"issue":"1","key":"5387_CR1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s11912-011-0203-y","volume":"14","author":"L Nayak","year":"2012","unstructured":"Nayak L, Lee EQ, Wen PY (2012) Epidemiology of brain metastases. 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IO is IASLC Board Director, Member of the Thoracic Clinical Practice Standards Committee and the Thoracic Education Committee of AATS, iMig Board Member and JTCVS Associate Editor. She is in the Stiftungsrat Schulthessklinik and an Advisory Board Member at Med Uni Wien for Comprehensive Center for Chest Diseases (CCCD).Michael Weller has received research grants from Novartis, Quercis and Versameb, and honoraria for lectures or advisory board participation or consulting from Nuvation, Bayer, Curevac, Hemerion, Iqvia, Medac, Novartis, Novocure, Orbus, Pfizer, Philogen, Roche and Servier.Emilie Le Rhun has received research grants from Bristol Meyers Squibb (BMS) and Servier, and honoraria for lectures or advisory board participation or consulting from Bayer, Biodexa \/ Sitoxi, Janssen, Leo Pharma, Medac, My Tomorrows, Pierre Fabre, Roche, Seattle Genetics and Servier.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"131"}}