Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community
Purpose: Currently, there is lack of consensus regarding the optimal treatment strategy (surgery versus radiotherapy) for intermediate-sized (2–4 cm) brain metastases (BM), especially those located in or near the motor cortex. This survey aims to gain insight into treatment decisions for these BM am...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000979 |
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| author | C.A.C. Jessurun D. Brandsma A. Compter P.C. de Witt Hamer R.J.A. Nabuurs A. Kloet M.L.D. Broekman P.V. ter Wengel |
| author_facet | C.A.C. Jessurun D. Brandsma A. Compter P.C. de Witt Hamer R.J.A. Nabuurs A. Kloet M.L.D. Broekman P.V. ter Wengel |
| author_sort | C.A.C. Jessurun |
| collection | DOAJ |
| description | Purpose: Currently, there is lack of consensus regarding the optimal treatment strategy (surgery versus radiotherapy) for intermediate-sized (2–4 cm) brain metastases (BM), especially those located in or near the motor cortex. This survey aims to gain insight into treatment decisions for these BM among the Dutch multidisciplinary neuro-oncology community. Methods: An electronic survey was distributed among neurosurgeons, radiation oncologists, neurologists, and medical oncologists in The Netherlands. The survey comprised 13 questions regarding physician's practices and questions about treatment decisions for BM in or near the motor cortex using statements and three theoretical patient cases. Results: Tumor size (n = 34, 89 %), degree of neurological deficit (n = 31, 82 %), and the need for (temporarily) discontinuation of immunotherapy because of dexamethasone dependence (n = 30, 79 %) were highlighted as the most important factors to steer the treatment decision to radiotherapy or surgery. When divided by specialty, 15 neurologists (33 %), 14 radiation oncologists (30 %), 12 neurosurgeons (26 %), and 5 medical oncologists (11 %), some variability about the importance of factors exists. The respondents suggested a median cutoff size of 3,5 cm for conducting surgery on BM. Conclusion: Surgical resection is preferred in patients with larger tumors, with neurologic symptoms that are unresponsive to dexamethasone, and in patients receiving immunotherapy. Future investigations should compare the effectiveness of surgical resection and stereotactic radiosurgery, and the effects on survival and quality of life in patients with BM in or near the motor cortex in a prospective and preferable randomized manner. |
| format | Article |
| id | doaj-art-cc744c2dbbcf477db614c54924afbba2 |
| institution | OA Journals |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-cc744c2dbbcf477db614c54924afbba22025-08-20T02:25:11ZengElsevierBrain and Spine2772-52942025-01-01510427810.1016/j.bas.2025.104278Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology communityC.A.C. Jessurun0D. Brandsma1A. Compter2P.C. de Witt Hamer3R.J.A. Nabuurs4A. Kloet5M.L.D. Broekman6P.V. ter Wengel7Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, Zuid-Holland, the Netherlands; Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, Zuid-Holland, the NetherlandsDepartment of Neuro-oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the NetherlandsDepartment of Neuro-oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the NetherlandsDepartment of Neurosurgery, Brain Tumor Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the NetherlandsDepartment of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, Zuid-Holland, the Netherlands; Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, Zuid-Holland, the NetherlandsDepartment of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, Zuid-Holland, the Netherlands; Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, Zuid-Holland, the NetherlandsDepartment of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, Zuid-Holland, the Netherlands; Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, Zuid-Holland, the Netherlands; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, United StatesDepartment of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, Zuid-Holland, the Netherlands; Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, Zuid-Holland, the Netherlands; Corresponding author. Department of Neurosurgery Haaglanden Medical Center Lijnbaan 32, 2512 VA, The Hague the Netherlands.Purpose: Currently, there is lack of consensus regarding the optimal treatment strategy (surgery versus radiotherapy) for intermediate-sized (2–4 cm) brain metastases (BM), especially those located in or near the motor cortex. This survey aims to gain insight into treatment decisions for these BM among the Dutch multidisciplinary neuro-oncology community. Methods: An electronic survey was distributed among neurosurgeons, radiation oncologists, neurologists, and medical oncologists in The Netherlands. The survey comprised 13 questions regarding physician's practices and questions about treatment decisions for BM in or near the motor cortex using statements and three theoretical patient cases. Results: Tumor size (n = 34, 89 %), degree of neurological deficit (n = 31, 82 %), and the need for (temporarily) discontinuation of immunotherapy because of dexamethasone dependence (n = 30, 79 %) were highlighted as the most important factors to steer the treatment decision to radiotherapy or surgery. When divided by specialty, 15 neurologists (33 %), 14 radiation oncologists (30 %), 12 neurosurgeons (26 %), and 5 medical oncologists (11 %), some variability about the importance of factors exists. The respondents suggested a median cutoff size of 3,5 cm for conducting surgery on BM. Conclusion: Surgical resection is preferred in patients with larger tumors, with neurologic symptoms that are unresponsive to dexamethasone, and in patients receiving immunotherapy. Future investigations should compare the effectiveness of surgical resection and stereotactic radiosurgery, and the effects on survival and quality of life in patients with BM in or near the motor cortex in a prospective and preferable randomized manner.http://www.sciencedirect.com/science/article/pii/S2772529425000979Brain metastasesMotor cortexSurgeryRadiation therapyRadiosurgery |
| spellingShingle | C.A.C. Jessurun D. Brandsma A. Compter P.C. de Witt Hamer R.J.A. Nabuurs A. Kloet M.L.D. Broekman P.V. ter Wengel Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community Brain and Spine Brain metastases Motor cortex Surgery Radiation therapy Radiosurgery |
| title | Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community |
| title_full | Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community |
| title_fullStr | Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community |
| title_full_unstemmed | Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community |
| title_short | Treatment decisions for intermediate-sized brain metastases in or near the motor cortex among the neuro-oncology community |
| title_sort | treatment decisions for intermediate sized brain metastases in or near the motor cortex among the neuro oncology community |
| topic | Brain metastases Motor cortex Surgery Radiation therapy Radiosurgery |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000979 |
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