Evidence map›Paper›PMID 39595822›Full record

ArticleBrain sciences2024

Surgical Resection Followed by Stereotactic Radiosurgery (S+SRS) Versus SRS Alone for Large Posterior Fossa Brain Metastases: A Comparative Analysis of Outcomes and Factors Guiding Treatment Modality Selection.

Ruth Lau, Enrique Gutierrez-Valencia, Anna Santiago, Carolyn Lai, Danyal Baber Ahmed, Parnian Habibi, Normand Laperriere, Tatiana Conrad, Barbara-Ann Millar, Mark Bernstein and 4 more

Abstract read
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In one paragraph

Article in Brain sciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Ruth LauDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.ORCID 0000-0002-8640-2339
Enrique Gutierrez-ValenciaDepartment of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada.
Anna SantiagoDepartment of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1X6, Canada.ORCID 0000-0002-0932-2386
Carolyn LaiDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.
Danyal Baber AhmedDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.ORCID 0000-0002-6903-0182
Parnian HabibiDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.
Normand LaperriereDepartment of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada.
Tatiana ConradDepartment of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada.
Barbara-Ann MillarDepartment of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada.
Mark BernsteinDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.
Paul KongkhamDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.
Gelareh ZadehDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.
David Benjamin ShultzDepartment of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada.
Aristotelis KalyvasDepartment of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada.ORCID 0000-0002-0222-488X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

objectivesAround 20% of cancer patients will develop brain metastases (BrMs), with 15-25% occurring in the posterior fossa (PF). Although the effectiveness of systemic therapies is increasing, surgery followed by stereotactic radiosurgery (S+SRS) versus definitive SRS remains the mainstay of treatment. Given the space restrictions within the PF, patients with BrMs in this location are at higher risk of brainstem compression, hydrocephalus, herniation, coma, and death. However, the criteria for treating large PF BrMs with S+SRS versus definitive SRS remains unclear.

methodsWe reviewed a prospective registry database (2009 to 2020) and identified 64 patients with large PF BrMs (≥4 cc) treated with SRS or S+SRS. Clinical and radiological parameters were analyzed. The two endpoints were overall survival (OS) and local failure (LF).

resultsPatients in the S+SRS group were more highly symptomatic than patients in the SRS group. Gait imbalance and intracranial pressure symptoms were 97% and 80%, and 47% and 35% for S+SRS and SRS, respectively. Radiologically, there were significant differences in the mean volume of the lesions [6.7 cm

conclusionsA higher proportion of patients treated with S+SRS presented with hydrocephalus, fourth-ventricle compression, and larger lesion volumes. SRS-alone patients had a lower KPS, a lower GPA, and more brain metastases. S+SRS correlated with improved OS, suggesting that it should be seriously considered for patients with large PF-BrM.

Indexed as

brain metastasesneurosurgeryposterior fossastereotactic radiosurgery

Identifiers

PMID39595822
PMCPMC11592184

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