Survival in patients with surgically treated brain metastases: does infratentorial location matter?

Abstract

Surgical resection is a common treatment modality for brain metastasis (BM). Location of the BM might significantly impact patient survival and therefore might be considered in clinical decision making and patient counseling. In the present study, the authors analyzed infra- and supratentorial BM location for a potential prognostic difference. Between 2013 and 2019, 245 patients with solitary BM received BM resection at the authors’ neuro-oncological center. In order to produce a covariate balance for commonly-known prognostic variables (tumor entity, age, preoperative Karnofsky Performance Score, and preoperative Charlson Comorbidity Index), a propensity score matching at a ratio of 1:1 between the cohort of patients with infra- and supratentorial BM location was performed using R. Overall survival (OS) rates were assessed for both matched cohorts of patients with BM. Sixty-one of 245 patients (25%) with solitary BM exhibited an infratentorial tumor location; 184 patients (75%) suffered from supratentorial solitary BM. Patients with infratentorial BM revealed a median OS of 11 months (95% confidence interval (CI) 7.4–14.6 months). Compared with this, median OS for the group of 61 individually matched patients with solitary supratentorial solitary BM was 13 months (95% CI 10.9-15.1 months) (p = 0.32). The present study suggests that the prognostic value of infra- and supratentorial BMs does not significantly differ in patients that undergo surgery for solitary BM. These results might encourage physicians to induce surgical therapy of supra- and infratentorial BM in a similar manner.

Synchronous versus metachronous spinal metastasis: a comparative study of survival outcomes following neurosurgical treatment

“…Functional status was further evaluated using the Karnofsky Performance Scale (KPS) upon admission, categorizing patients into KPS ≥ 70% or KPS < 70%, as previously described (Schuss et al 2021 ; Hamed et al 2023 ; Schweppe et al 2023 ; Ilic et al 2021 ). The Charlson Comorbidity Index (CCI) was employed to quantify the comorbidity burden of patients before undergoing surgery (Hamed et al 2022a ; Schneider et al 2020 ; Lehmann et al 2023 ).…”

Outcome assessment of intraoperative radiotherapy for brain metastases: results of a prospective observational study with comparative matched-pair analysis

“…Besides receiving a histopathological diagnosis in case of cancer of unknown primary, criteria for surgical resection were presence or severe risk of acute neurological impairment or clinically significant mass effects as abnormal intracranial pressure or hemispheric shift. In case of multiple BMs, only the clinically manifest lesion was considered for surgical removal to prevent mass effects and tumor-related hydrocephalus [ 28 , 30 ]. Clinical inclusion criteria for IORT were gross total resection, intraoperative confirmation of BM on frozen tumor sections, no previous intracerebral irradiation and fulfillment of dose constraints as described below.…”

Synchronous versus metachronous spinal metastasis: a comparative study of survival outcomes following neurosurgical treatment

“…Functional status was further evaluated using the Karnophysky Performance Scale (KPS) upon admission, categorizing patients into KPS ≥ 70% or KPS < 70%, as previously described [28][29][30][31]. The Charlson Comorbidity Index (CCI) was employed to quantify the comorbidity burden of patients before undergoing surgery [32][33][34].…”