title: Posterior fossa metastases: aggressive treatment improves survival.
abstract: BACKGROUND
  Brain metastases are a leading cause of mortality and morbidity in patients with malignancies. Infratentorial location has been considered a negative prognostic factor.
  
  
  METHODS
  This retrospective study evaluated patients with cerebellar metastasis. Statistical analysis assessed age, extracranial disease, performance status and treatment. Patients were categorized by Radiation Therapy Oncology Group recursive partitioning analysis (RPA). Treatment included surgery, stereotactic radiosurgery (SRS) and whole brain radiotherapy (WBRT) alone or in combination.
  
  
  RESULTS
  Of 93 patients, the median survival was 12.9 months for RPA class I, 11 months for class II and 8 months for class III. On multivariate analysis, RPA class was an important predictor for overall survival. However, SRS with WBRT or surgery with WBRT or a combination of SRS, surgery and WBRT, was more favorable than surgery or SRS alone within RPA class II patients.
  
  
  CONCLUSIONS
  Survival of patients with cerebellar brain metastasis is comparable to that of patients with supratentorial brain metastasis using RPA classification. Aggressive multimodality therapy has a favorable impact on survival.
authors.affiliation: Department of Neurosurgery, Brain Tumor Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Kanner
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
authors.forename: Vitaly E
authors.initials: VE
authors.lastname: Siomin
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Lee
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis