Metastases to the cerebellum. Results and prognostic factors in a consecutive series of 44 operated patients.
BACKGROUND
Recent reports on large number of patients with brain metastases report that Whole Brain Radiotherapy (WBRT) and Radiosurgery (RS) should be the treatments of choice, particularly in multiple lesions cases. Among the prognostic factors, the cerebellar location was never considered, although this results in hydrocephalus, brain stem compression, ataxia, intracranial hypertension.


METHODS
We evaluated 44 patients with cerebellar metastases operated over 6 years. Primary lesions were: Lung (15), Breast (12), Gastrointestinal (9), Gut (3), Ovary (2), Melanoma (1), Salivary gland carcinoma (1), Unknown (1). Lesions were <3 cm in 11 cases, > or =3 cm in 33. Average KPS scoring at admission was 69.9. Twenty nine scored > or =70, 15 < 70.


RESULTS
Two patients died for surgical complications, 2 died within 1 months for other causes, 2 were lost to follow up. Eight had postoperative hematoma requiring reoperation, 1 had an occipital infarction. Average KPS scoring at discharge was 76.4, P < 0.002. Those patients that had complications scored less, the difference is significant (P < 0.008). Median survival was 8 months, 1 year survival rate 29.9%. Survival was correlated with either admission or discharge KPS (> or =70 vs. <70): P = 0.05 and P = 0.0001 respectively. None of the other parameters considered reached statistical significance.


CONCLUSIONS
Open microneurosurgery is probably still the most effective therapy in improving survival and KPS in patients with large cerebellar metastases, given that the proper surgical technique is used and that complications do not occur. Specific data on cerebellar metastases as an independent subgroup are needed from radiosurgical series.
Pompili
Alfredo
A
Division of Neurosurgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. pompili@ifo.it
Carapella
Carmine Maria
CM
Cattani
Fabio
F
Fabi
Alessandra
A
Giannarelli
Diana
D
Giovannetti
Maddalena
M
Mirri
Alessandra
A
Occhipinti
Emanuele
E
Telera
Stefano
S
Vidiri
Antonello
A
Pace
Andrea
A
D000328:Adult; D000368:Aged; D002528:Cerebellar Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D016634:Radiosurgery; D011878:Radiotherapy