SADA-19 SURGICAL OUTCOMES IN CEREBELLAR BRAIN METASTASES: A MULTICENTER COHORT STUDY
Tommaso Araceli, Matthias Demetz, Judith Rösler, Christian Freyschlag, Claudius Thomé, Katharina Faust, Peter Vajkoczy, Nils Ole Schmidt, Martin Proescholdt, Julia Onken, David WasilewskiAbstract
Background and Objective
Cerebellar brain metastases (BM) present unique clinical challenges due to their critical location and association with hydrocephalus and hemorrhage. Surgical resection remains an essential treatment, but real-world outcome data in the modern systemic therapy era are limited.
Methods
We retrospectively analyzed 201 patients who underwent resection of cerebellar metastases between 2017 and 2024 across four tertiary care centers. Baseline clinical characteristics, postoperative Karnofsky Performance Status (KPS), Graded Prognostic Assessment (GPA), hydrocephalus (clinical and radiological), hemorrhage status, and extracranial disease were collected. Overall survival (OS) was estimated using Kaplan–Meier analysis. Median survival with 95% confidence intervals (CI) was calculated using bootstrap resampling. Spearman correlation was applied to assess associations between clinical variables.
Results
The cohort included 52% males and 48% females, with a median age of 65 years. Clinical hydrocephalus was present in ∼30%, and radiological hydrocephalus in ∼35%. Hemorrhagic metastases occurred in ∼25%, while 10% presented with massive intracranial hemorrhage. Postoperative KPS ≥ 70 was achieved in the majority (65%). At last follow-up, ∼65% of patients were deceased. Median OS was 11.2 months (95% CI: 9.4–13.1). One-year survival was 47%, and two-year survival was 25%. Prognosis was significantly influenced by postoperative KPS, GPA, presence of extracranial metastases, and clinical hydrocephalus at baseline. Spearman correlation demonstrated strong associations between tumor and edema volume (p = 0.29) as well as tumor volume and clinical hydrocephalus (p = 0.58), whereas radiological hydrocephalus correlated only weakly with clinical hydrocephalus (p = 0.07).
Conclusions
In this contemporary multicenter cohort of 201 patients, surgical resection of cerebellar metastases achieved a median survival of about one year. Functional status and systemic disease burden remain the strongest predictors of outcome. These data provide a modern benchmark for clinical decision-making and trial design in patients with cerebellar BM.