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Purpose <p>Surgery with stereotactic radiosurgery/therapy (SRS/SRT) has become routine in the management of brain metastases. Generally, lesions ≥ 3&#xa0;cm maximal diameter require surgery plus SRS/SRT and those &lt; 1&#xa0;cm receive radiation alone. Optimal treatment for intermediate tumors (1–3&#xa0;cm diameter) remains unclear, particularly tumors in the primary motor cortex (PMC). Previous literature supports safe resection of these lesions, but studies are confounded. SRS/SRT-alone offers a non-invasive treatment avoiding surgical risks.</p> Methods <p>This case matched study compared neurologic and oncologic outcomes of SRS/SRT-alone versus surgical resection with adjuvant SRS/SRT (Surg + SRS/SRT) for management of PMC metastases. Patients were matched by tumor diameter, primary malignancy radiosensitivity, and performance status. Demographics, tumor characteristics, treatment details, and outcomes were studied.</p> Results <p>242 patients with PMC metastases were identified, 60 treated with Surg + SRS/SRT and 182 with SRS/SRT-alone. Case-matching identified 30 exact matches. There were no differences in demographics, preoperative neurological status or performance status between groups. The SRS/SRT-alone group had a higher percentage of post-treatment motor deficit (80% versus 47%, <i>p</i> = 0.007), with a lower median post-treatment strength grade (4[IQR3-4] versus 5[IQR4-5], <i>p</i> = 0.003). The Surg + SRS/SRT group had a higher rate of patients achieving post-treatment strength grade 5 (53.3% versus 16.7%, <i>p</i> = 0.003) and more often experienced post-treatment motor improvement (56% versus 4.8%, <i>p</i> &lt; 0.001). No patients experienced a decline in motor function following Surg + SRS/SRT (0% versus 26.7%, <i>p</i> = 0.009).</p> Conclusion <p>In a case matched analysis, Surg + SRS/SRT for intermediately sized PMC metastases demonstrated a greater degree of strength improvement, achieved higher overall motor scores and resulted in no motor deficits compared to SRS/SRT-alone.</p>

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Management of intermediate-sized brain metastases of the primary motor cortex

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Mark A. Damante,
  • Guilherme Finger,
  • Ryan B. Juncker,
  • Daniel C. Kreatsoulas,
  • Dukagjin Blakaj,
  • Raju Raval,
  • Raj Singh,
  • Joshua D. Palmer,
  • Pierre Giglio,
  • Pawan Singh,
  • Hamid Mohtashami,
  • Russell R. Lonser,
  • Kyle C. Wu,
  • James Bradley Elder

摘要

Purpose

Surgery with stereotactic radiosurgery/therapy (SRS/SRT) has become routine in the management of brain metastases. Generally, lesions ≥ 3 cm maximal diameter require surgery plus SRS/SRT and those < 1 cm receive radiation alone. Optimal treatment for intermediate tumors (1–3 cm diameter) remains unclear, particularly tumors in the primary motor cortex (PMC). Previous literature supports safe resection of these lesions, but studies are confounded. SRS/SRT-alone offers a non-invasive treatment avoiding surgical risks.

Methods

This case matched study compared neurologic and oncologic outcomes of SRS/SRT-alone versus surgical resection with adjuvant SRS/SRT (Surg + SRS/SRT) for management of PMC metastases. Patients were matched by tumor diameter, primary malignancy radiosensitivity, and performance status. Demographics, tumor characteristics, treatment details, and outcomes were studied.

Results

242 patients with PMC metastases were identified, 60 treated with Surg + SRS/SRT and 182 with SRS/SRT-alone. Case-matching identified 30 exact matches. There were no differences in demographics, preoperative neurological status or performance status between groups. The SRS/SRT-alone group had a higher percentage of post-treatment motor deficit (80% versus 47%, p = 0.007), with a lower median post-treatment strength grade (4[IQR3-4] versus 5[IQR4-5], p = 0.003). The Surg + SRS/SRT group had a higher rate of patients achieving post-treatment strength grade 5 (53.3% versus 16.7%, p = 0.003) and more often experienced post-treatment motor improvement (56% versus 4.8%, p < 0.001). No patients experienced a decline in motor function following Surg + SRS/SRT (0% versus 26.7%, p = 0.009).

Conclusion

In a case matched analysis, Surg + SRS/SRT for intermediately sized PMC metastases demonstrated a greater degree of strength improvement, achieved higher overall motor scores and resulted in no motor deficits compared to SRS/SRT-alone.