Artikel
Metastases to the cerebellum. Results and prognostic factors in a consecutive series of 44 operated patients
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Autoren
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A. Pompili
- Division of Neurosurgery, “Regina Elena” National Cancer Institute, Rome, Italy
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F. Cattani
- Division of Neurosurgery, “Regina Elena” National Cancer Institute, Rome, Italy
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A. Fabi
- Division of Medical Oncology A, “Regina Elena” National Cancer Institute, Rome, Italy
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D. Giannarelli
- Biostatistical Unit, “Regina Elena” National Cancer Institute, Rome, Italy
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M. Giovanetti
- Service of Anesthesiology, “Regina Elena” National Cancer Institute, Rome, Italy
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A. Mirri
- Division of Radiotherapy, “Regina Elena” National Cancer Institute, Rome, Italy
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E. Occhipinti
- Division of Neurosurgery, “Regina Elena” National Cancer Institute, Rome, Italy
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S. Telera
- Division of Neurosurgery, “Regina Elena” National Cancer Institute, Rome, Italy
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A. Vidiri
- Service of Diagnostic Radiology and Imaging, “Regina Elena” National Cancer Institute, Rome, Italy
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A. Pace
- Division of Neurosurgery, “Regina Elena” National Cancer Institute, Rome, Italy
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Recent reports on a large number of patients with brain metastases report that Whole Brain Radiotherapy (WBRT) and Radiosurgery (RS) should be considered as the treatments of choice, particularly in multiple lesions cases. Surprisingly, among the prognostic factors, the cerebellar location was never considered, although this results in early hydrochephalus, brain stem compression, severe ataxia, intracranial hypertension. The objective of this study is to determine whether surgical therapy is still suitable for cerebellar metastases.
Methods: We evaluated 44 patients with single/solitary cerebellar metastases operated upon in 2001 - June, 2006. Primary lesions were: Lung (15), Breast (11), gastrointestinal (7), Gut (3), Melanoma (1), Salivary gland carcinoma (1), Unknown (1). Two surgical approaches were used depending on the location of the lesion: traditional suboccipital (33) and occipital transtentorial (11). Lesions were <3 cm in 11 cases, =3 cm in 33. Average KPS scoring at admission was 69.9. 28 scored =70, 16 <70.
Results: 2 patients died because of surgical complications, 2 died within one month for other reasons, 2 were lost to follow-up. 3 patients required postoperative temporary CSF diversion, 8 had postoperative cerebellar hematoma requiring reoperation, 1 had an occipital infarction, 2 an occipital hematoma. Average KPS scoring at discharge was 76.4, p<0.002. Those patients, who had complications scored less, the difference being significant (p<0.008). A satisfying KPS was maintained by all the patients until a few weeks before death. Median survival was 7 months, 1 year rate 28.5%. Survival was correlated with either admission or discharge KPS (=70 versus < 70): p=0.05 and p=0.0001 respectively. Other parameters were considered: time to metastases, systemic disease, postoperative WBRT or RS, intracranial recurrence, histology, primary tumor location: none reached statistical significance.
Conclusions: Open microneurosurgery is probably still the most effective therapy in improving survival and KPS in patients with large cerebellar metastases, given that the proper surgical technique is used and that complications do not occur.
