Artikel
Comparison of the early functional outcome after electrophysiological controlled microsurgery versus stereotactic LINAC radiotherapy of cerebral metastasis of the Rolandic area
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: To evaluate the advantages and disadvantages regarding the functional outcome and factors of influence of the two standard treatment options for central metastases: electrophysiologically controlled microsurgery or stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT).
Methods: We performed a database search for central metastasis treatments during the period from january 2008 till september 2012 in two clinical registers: 1. register for intraoperative neuromonitoring (Department of Neurosurgery) and 2. prospective database for SRS/SRT (Department of Radiotherapy). Neurological status before and after treatment, Karnofsky performance index (KPI), histology, tumor localisation, tumor volume and oncological status were standardized and pooled together. The muscle strength was graded on a scale of 0-5.
Results: We identified 27 microsurgical and 41 stereotactic cases in 68 patients. The microsurgically treated patients had significant less muscle strength in the upper and lower extremities before and after the treatment compared to the patients which received radiotherapy. The muscle strength of the limbs did not change in the patients which received radiotherapy, while operated patients had significant improvement of the muscle strength of the lower extremities (p=0.05) and a non-significant improvement in the upper extremities. There was a significant higher improvement rate of hemiparesis but as well a statistical trend for more deterioration of the muscle strength of the limbs after microsurgery compared to SRS/SRT (improvement p=0.04, deterioration p=0.10).
Conclusion: Electrophysiologically guided microsurgicy of central metastases had a significant better functional outcome regarding hemiparesis. However there was also a trend for less secondary neurological deterioration after stereotactic radiosurgery or stereotactic radiotherapy.