• Neurosurgery · Jul 2019

    Peritumoral Edema/Tumor Volume Ratio: A Strong Survival Predictor for Posterior Fossa Metastases.

    • Gauthier Calluaud, Louis-Marie Terrier, Bertrand Mathon, Christophe Destrieux, Stéphane Velut, Patrick François, Ilyess Zemmoura, and Aymeric Amelot.
    • CHRU de Tours, Department of Neurosurgery, Tours, France.
    • Neurosurgery. 2019 Jul 1; 85 (1): 117-125.

    BackgroundTwenty percent of all brain metastases (BM) occur in the posterior fossa (PF). Radiotherapy sometimes associated with surgical resection remains the therapeutic option, while Karnovsky performance status and graded prognostic assessment (GPA) are the best preoperative survival prognostic factors.ObjectiveTo explore the prognostic role of peritumoral brain edema in the PF, which has never been explored though its role in supratentorial BM has been debated.MethodsA total of 120 patients diagnosed with PF metastasis who underwent surgical resection were included retrospectively in this analysis. Clinical data were retrieved from electronic patient medical files. The tumor volumes and their associated edema were calculated via manual delineation; subsequently the edema/tumor volume ratio was determined.ResultsIn multivariate analysis with Cox multivariate proportional hazard model, the edema to tumor volumes ratio (hazard ratio [HR]: 1.727, 95% confidence interval [CI] 1.427-2.083; P < .0001) was identified as a new strong independent prognosis factor on overall survival (OS) whereas edema volume alone was not (P = .469). Moreover, BM complete resection (HR: 0.447, 95% CI 0.277-0.719; P < .001), low (0-1) World Health Organization status at diagnosis (HR: 2.109, 95% CI 1.481-3.015; P < .0001), high GPA class at diagnosis (HR: 1.77, 95% CI 0.9-2.9; P < .04), and postoperative brain irradiation (HR: 2.019, 95% CI 1.213-3.361; P < .007] were all confirmed as independent predictive factors for survival.ConclusionThe edema/tumor ratio appears to greatly influence OS in patients suffering from PF metastases unlike the extent of edema alone. This easily determined as well as strong prognostic factor could be used as an interesting tool in clinical practice to help the management of these patients.Copyright © 2018 by the Congress of Neurological Surgeons.

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