SADA-19 SURGICAL OUTCOMES IN CEREBELLAR BRAIN METASTASES: A MULTICENTER COHORT STUDY

CLTR-02 OUTCOMES OF SURGICAL RESECTION IN PATIENTS WITH MORE THAN ONE BRAIN METASTASIS

Abstract Historically, surgical resection was confined to patients with a single brain metastasis (BM). Currently, more effective systemic therapies give improved extracranial disease control, highlighting the need for intracranial symptom and disease control. Therefore, we evaluated outcomes of surgical resection as part of initial local management in patients with multiple BMs. A single center retrospective cohort study was performed. Primary outcome measure was overall survival (OS), the secondary outcome measures were intracranial progression-free survival (iPFS) and extracranial PFS (ePFS). Kaplan-Meier and Cox Proportional Hazards methods were used. Between 1-1-2010 and 31-12-2023, 613 patients underwent BM resection. Of these patients, 131 patients had more than one BM and were included in the study. Median OS was 10.6 months (95% CI: 7.3-14.0 months). Median iPFS was 5.3 months (95% CI: 4.0-6.6 months), median ePFS was 7.5 months (95% CI: 4.2-10.8 months). Patients with melanoma (HR 0.273, 95% CI: 0.110-0.675, p = 0.005), post-surgery stereotactic radiotherapy (HR 0.446, 95% CI: 0.264-0.753, p = 0.002), whole brain radiation therapy (HR 0.598, 95% CI: 0.358-0.997, p = 0.049), systemic treatment (HR 0.370, 95% CI: 0.230-0.595, p < 0.001) or a Karnofsky performance score (KPS) ≥ 70 (HR 0.201, 95% CI: 0.108-0.374, p < 0.001) had a statistically significant lower risk of death from any cause. Age was inversely correlated with mortality (HR 1.023, 95% CI 1.001-1.045, p = 0.036). Of patients with a KPS < 70 (n = 18), only one patient survived more than one year. In conclusion: surgical resection in selected patients with multiple BMs in a good clinical condition provides a meaningful OS and iPFS, possibly by creating a window of opportunity for SRT and systemic therapies.

Long-Term Survival in Patients with Supratentorial Glioblastomas: Insights from Multimodal Treatment and Neuroimaging

Improved survival correlates with gross total resection, thorough chemoradiotherapy, non-midline tumor positioning, and positive MRI characteristics, emphasizing the significance of extensive safe surgery and advanced imaging for predicting outcomes.

Distinct clinical characteristics and prognostic factors of pediatric meningiomas in a 10-year cohort of 198 patients

A Permanent but Not Transient Postoperative Deficit Has Impact on OS and PFS in IDHwt-Glioma Patients

Background/Objectives: Neurological impairment after glioma resection is a common postoperative event, but many deficits improve during recovery. The present study investigated whether transient and persistent postoperative neurological deficits differ in their association with overall survival (OS) and progression-free survival (PFS). Methods: We retrospectively reviewed data from patients who underwent initial surgical treatment for glioma in our institution. Neurological function was evaluated using documented clinical examinations performed before surgery, in the immediate postoperative period, and during routine follow-up 3–6 months after the procedure. Results: The study cohort comprised 496 patients, of whom 44.4% were women. The mean age at surgery was 60 years (95% CI, 58–61), and the average follow-up period was 21 months (95% CI, 19–23). According to the 2021 WHO classification, 80.0% of tumors were grade 4, 11.1% were grade 3, and 7.3% were grade 2. IDH mutations were absent in 81% of cases. Median survival for the entire cohort was 34 months (95% CI, 30–38). Preoperative neurological deficits, including hemiparesis, were not significantly associated with OS. Postoperative deficits that were resolved by the follow-up assessment showed no relationship with either OS or PFS, irrespective of IDH mutation status. In contrast, neurological deficits that persisted at follow-up were independently associated with shorter OS and PFS among patients with IDH-wild-type gliomas (p < 0.001), whereas no significant association was observed in the IDH-mutant subgroup. Similarly, when new neurological deficits were present at follow-up, poorer OS and PFS were predicted only in patients with IDH-wild-type tumors (p < 0.001). Conclusions: Temporary neurological deterioration following glioma surgery does not appear to adversely influence overall or progression-free survival, regardless of IDH status. However, persistent postoperative deficits, as well as newly acquired deficits that remain evident during follow-up, are strong indicators of an unfavorable prognosis in patients with IDH-wild-type gliomas.

SADA-17 SURVIVAL AND LOCAL CONTROL AFTER RESECTION AND GAMMATILE BRACHYTHERAPY FOR NEWLY DIAGNOSED BRAIN METASTASES: A PROSPECTIVE REGISTRY ANALYSIS

Abstract Background Surgical resection is a standard treatment for large and/or symptomatic newly diagnosed brain metastases (BM). GammaTile brachytherapy delivers immediate intracavitary radiation at surgery and may reduce delay in postoperative treatment. Despite increased usage and adoption, prospective data remain limited. Methods We analyzed an ongoing multicenter, prospective Phase IV registry (NCT0442738) of patients undergoing BM resection followed by GammaTile brachytherapy. Primary outcome was overall survival (OS); secondary outcomes were local control (LC) and distant brain failure (DBF). Time-to-event endpoints were estimated by Kaplan-Meier methods, and Cox models were used to identify predictors of outcome. Results 89 patients with 95 lesions were treated with resection and brachytherapy. Median age was 64 years (range: 28–81), 56.2% were male, and median KPS score was 80 (range: 30-100). Primary histology included predominantly lung (36%), followed by melanoma (12.4%) and breast (11.2%). The median BM diameter was 3.2cm (range 1.1-5.5cm) and most lesions were supratentorial (84.2%). Gross total resection was achieved in 86.3% of patients. At analysis, 48.8% of patients had died. Median OS was 8.6 months (95% CI: 6.0-20.1 months), with 6- and 12-month OS rates of 59.4% and 45.1%, respectively. Local failure occurred in 7.9% patients. The 6- and 12-month LC rates were 96.9% and 92.5%, respectively. DBF occurred in 19% of patients, with 6- and 12-month DBF-free rates of 82.2% and 68.4%. Melanoma histology was associated with worse DBF on multivariable analysis (HR: 5.31, p=0.043). Seizures occurred in 6.7% of patients, while intracerebral hemorrhage and cerebral edema were observed in 1.1% and 2.2% patients, respectively. Conclusions In this prospective registry, resection followed by GammaTile brachytherapy achieved excellent local control, and manageable toxicity in newly diagnosed BM. These findings support that GammaTile brachytherapy is a promising strategy for large or symptomatic BM. Future work to better define patient selection is planned.

Clinical, molecular, and surgical predictors of outcome in non-DIPG pediatric diffuse midline gliomas: A collaborative retrospective analysis