LOCL-13 SURGICAL RESECTION PLUS STEREOTACTIC RADIOSURGERY (SRS) VERSUS SRS ALONE FOR LARGE POSTERIOR FOSSA BRAIN METASTASES: OUTCOMES AND FACTORS GUIDING THE DECISION OF TREATMENT MODALITY
Bibliographic record
Abstract
Abstract INTRODUCTION Approximately 20% of brain metastases (BM) occur in the posterior fossa (PF). However, the criteria to treat large PF BM with surgery (S) followed by stereotactic radiosurgery (SRS) or SRS alone are still unclear. We aim to identify parameters that can help in the decision of treating PF BM with S+SRS or SRS and to compare outcomes between the two groups. METHODOLOGY We reviewed a prospective registry database (2009 to 2020) and identified all patients with PF BM (≥4cc in volume) treated with SRS or S+SRS. Clinical and radiological, parameters were analyzed. We examined two endpoints: Overall Survival (OS) and Local Failure (LF). RESULTS 64 patients were identified; 30 were treated with S+ SRS and 34 with SRS. Gait imbalance and Intracranial pressure symptoms were significantly different between the groups; 97% and 80% for S+SRS vs 47% and 35% for SRS, respectively. Radiologically, there were significant differences in the mean volume of the lesions [6.7 cm3 in SRS vs 29.8cm3 in S+SRS cohort] (p<0.001), compression of the IV ventricle (47% in SRS vs 96% in S+SRS cohort, (p<0.001)) and hydrocephalus (0% in SRS vs 29% in S+SRS cohort, (p<0.001)). One surgical patient required salvage SRS and two SRS patients required salvage S. Patients with S+SRS (HR 0.35, p<0.001) and higher GPA scores (HR 0.62, p=0.007) correlated with better OS. There was no significant difference in rates of LF between the 2 groups. CONCLUSIONS Patients treated with S+SRS were more likely to be symptomatic, have larger tumors, and have compression of the IV ventricle with hydrocephalus. Non-symptomatic patients with moderately sized lesions were safely managed with SRS. S+SRS treatment and higher GPA were associated with improved OS.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".