gms | German Medical Science

Objective: Up to 40% of cancer patients develop brain metastases during the course of their illness. Focusing on the cerebellar location the incidence of filiae is about 15% compared to the remaining cerebrum. We reviewed the treatment strategies and outcome of those patients in our department.

Methods: A total of 264 patients were admitted between July 2003 and November 2008 to our department due to brain metastases. From our database we identified 54 (20%) patients with at least 1 cerebellar filia. Retrospectively we analysed the management of treatment and the outcome.

Results: The sites of primary malignancies were: 19 lung (18 NSCLC, 1 SCLC), 11 breast, 10 gastrointestinal, 4 unknown primaries, and 8 others (4 urogenital, 1 melanoma, 1 sarcoma, 1 pharyngeal, and 1 thyroidal carcinoma). There were two cases with several primary malignancies (colon + SCLC and NSCL + SCLC + thyroidal cancer). Thirty-six (67%) patients had a singular or solitary brain metastasis, 5 (9%) patients had 2 metastases, 7 (13%) patients had 3 metastases, and 6 (11%) patients had more than 4 brain lesions. The initial treatment was microsurgical extirpation in 50 patients, which was followed by radiation in 23 cases (17 whole brain radiation and 6 Gamma-knife). Surgery alone was performed in 28 cases. Four patients were managed non-surgically (1 primary Gamma-knife and 1 whole brain radiation as well as 2 which were not treated at all). In general the median survival for surgery alone was 9.6 months versus 18.7 months in combination with radiation. Divided into malignancy subgroups: in cases of surgery alone the overall survival for lung cancer was 8.6 months versus 15.2 months in combination with radiation, for breast cancer 17.0 versus 40.6 months, for gastrointestinal cancer 4.6 versus 16.2 months, carcinoma of unknown primary 1.3 versus 10.9 months, and the combined urogenital, melanoma, sarcoma, thyroidal and pharyngeal metastases 4.9 versus 7.4 months.

Conclusions: Cerebellar metastases are less frequent, but more often an indication for rapid neurosurgical intervention due to mass effects. Regarding the treatment options surgery plus radiation significantly improves the outcome in comparison to surgery alone, even in patients with a poor Karnofsky index.