Jessurun C A C, Brandsma D, Compter A, de Witt Hamer P C, Nabuurs R J A, Kloet A, Broekman M L D, Ter Wengel P V
Department 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.
Brain Spine. 2025 May 12;5:104278. doi: 10.1016/j.bas.2025.104278. eCollection 2025.
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.
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.
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.
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.
目前，对于中等大小（2 - 4厘米）脑转移瘤（BM），尤其是位于运动皮层或其附近的脑转移瘤，最佳治疗策略（手术与放疗）尚无共识。本调查旨在深入了解荷兰多学科神经肿瘤学界对这些脑转移瘤的治疗决策。
在荷兰的神经外科医生、放射肿瘤学家、神经科医生和医学肿瘤学家中进行了一项电子调查。该调查包括13个关于医生实践的问题，以及使用陈述和三个理论患者病例对运动皮层或其附近脑转移瘤治疗决策的问题。
肿瘤大小（n = 34，89%）、神经功能缺损程度（n = 31，82%）以及因地塞米松依赖而需要（暂时）停用免疫治疗（n = 30，79%）被强调为指导放疗或手术治疗决策的最重要因素。按专业划分时，15名神经科医生（33%）、14名放射肿瘤学家（30%）、12名神经外科医生（26%）和5名医学肿瘤学家（11%）对各因素的重要性存在一定差异。受访者建议对脑转移瘤进行手术的中位临界大小为3.5厘米。
对于肿瘤较大、对皮质类固醇无反应的神经症状患者以及接受免疫治疗的患者，首选手术切除。未来的研究应以前瞻性且最好是随机的方式比较手术切除和立体定向放射外科的有效性，以及对运动皮层或其附近脑转移瘤患者生存和生活质量的影响。
