A Permanent but Not Transient Postoperative Deficit Has Impact on OS and PFS in IDHwt-Glioma Patients

The effects of postoperative neurological deficits on overall survival in patients with malignant peripheral nerve sheath tumors.

OBJECTIVE Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas with peripheral nerve differentiation. Surgical management of MPNSTs entails wide resection with negative margins, although the extent of resection required to achieve oncological control may result in postoperative neurological morbidity. The association between postoperative neurological deficits and survival outcomes in patients with MPNSTs remains poorly defined. In this study, the authors evaluated the association between new or worsening postoperative neurological deficits and overall survival (OS) following resection for MPNSTs. METHODS A retrospective review of all patients who underwent resection for MPNSTs at Johns Hopkins Hospital between 2010 and 2024 was performed. Postoperative neurological deficits were defined as new or worsened motor or sensory impairment documented on postoperative examination compared with preoperative baseline. Deficits were classified as transient if they resolved within 3 months or permanent if they persisted beyond 3 months. OS was assessed using Kaplan-Meier analysis. Uni- and multivariable Cox proportional hazards models were used to evaluate the association between postoperative neurological deficits and OS, adjusting for tumor characteristics and extent of resection. RESULTS A total of 116 patients underwent resection during the study period, 49 (42.2%) of whom developed a postoperative neurological deficit. The median overall follow-up duration was 20.6 (interquartile range 8.6-56.2) months. Permanent neurological deficits were more common among patients with spinal tumors (35.3% vs 11.9%, p = 0.046). The presence of a permanent deficit was associated with worse OS (hazard ratio [HR] 3.64, 95% CI 1.97-6.72) compared with transient or no deficits. When stratified by extent of resection, patients who underwent gross-total resection (GTR) without a neurological deficit demonstrated the longest OS, followed by GTR with a deficit, subtotal resection (STR) without a deficit, and STR with a deficit. On multivariable analysis, the development of a permanent postoperative neurological deficit remained independently associated with worse OS (HR 8.50, 95% CI 2.77-14.59). CONCLUSIONS In patients undergoing resection for MPNSTs, the development of a permanent postoperative neurological deficit was independently associated with decreased OS. These findings underscore the importance of balancing maximal oncological resection with preservation of neurological function to optimize long-term outcomes in patients with MPNSTs.

CLTR-02 OUTCOMES OF SURGICAL RESECTION IN PATIENTS WITH MORE THAN ONE BRAIN METASTASIS

Surgical resection in selected patients with multiple BMs in a good clinical condition provides a meaningful OS and iPFS, possibly by creating a window of opportunity for SRT and systemic therapies.

SADA-19 SURGICAL OUTCOMES IN CEREBELLAR BRAIN METASTASES: A MULTICENTER COHORT STUDY

In this contemporary multicenter cohort of 201 patients, surgical resection of cerebellar metastases achieved a median survival of about one year, and functional status and systemic disease burden remain the strongest predictors of outcome.

NOTQ-07 PREOPERATIVE NEUROLOGICAL IMPAIRMENT AND FUNCTIONAL STATUS IN INFILTRATIVE VERSUS NON-INFILTRATIVE BRAIN METASTASES: A COMPARATIVE STUDY

Abstract Background Infiltrative growth patterns (HGPs) in brain metastases (BM) has been linked to greater neurological morbidity and poorer clinical outcomes. However, its quantitative effect on presurgical neurological deficits and functional status remains insufficiently characterized. Methods Following the previously established MetInfilt protocol, brain–tumor interface specimens were prospectively obtained and analyzed histologically in patients undergoing resection of one or more BM between June 2019 and September 2025. Infiltrative growth was assessed on H&E- and IHC-stained interface sections. A cohort of 50 patients was matched for sex, age, metastatic status and timing, primary tumor type, and lesion location. Presurgical functional status was evaluated using the Karnofsky Performance Status (KPS). Neurological deficits included hemiparesis, visual field impairment, aphasia, and seizures. Differences in KPS were analyzed using a two-sample t-test assuming equal variances, while categorical variables were compared using Pearson’s chi-square test. Results Infiltrative BM were identified in 76.3% of patients. Those without infiltrative tumors demonstrated a higher median presurgical KPS (90, range 50–100) compared with patients exhibiting infiltrative growth (80, range 40–90). The mean difference in KPS was 9.35 points (t = 1.70, p = 0.038). Hemiparesis was observed in 11.1% of patients without infiltration versus 51.7% with infiltration (p = 0.042). Aphasia occurred in 11.1% of non-infiltrative cases compared with 51.7% in infiltrative cases (p = 0.024). Seizures were reported in 11.1% of non-infiltrative tumors and 48.3% of infiltrative tumors (p = 0.033). No significant difference was found for visual field deficits (p = 0.405). Conclusions Infiltrative BM are associated with reduced presurgical functional status and a markedly higher frequency of hemiparesis, aphasia, and seizures, indicating an increased neurological burden prior to surgical treatment.

Long-term outcomes after adjuvant radiotherapy in adult spinal ependymomas: a multicenter study by the trod Neuro-Oncology research group (07 − 005)

When the cure becomes the curse: Radiation-induced glioma of the pons in children surviving craniopharyngioma

Abstract Background The standard of care for pediatric craniopharyngioma (CP) is either complete surgical resection or limited debulking surgery followed by adjuvant radiotherapy (RT). Recent data favor the latter approach. Methods We present a multi-center case series of three children with CP treated with subtotal surgery and adjuvant RT for CP who eventually developed radiation-induced glioma (RIG) of the pons. Results The median age at diagnosis of CP was 6 years. Photon RT was administered in two patients and proton RT in one, at a median dose of 54 Gy delivered in 30 fractions. Pontine glioma was first identified on imaging after a median interval of 8 years from initial RT (range 4.5 - 9.75 years), incidentally in two asymptomatic patients during routine surveillance, and associated with symptoms of brainstem involvement in one. A biopsy was performed in two patients. One showed diffuse astrocytoma with MYCN, PDGFRA, and MDM2 amplification and a novel fusion (RBD7-FLI1), while the other case had an inconclusive histopathology. Re-irradiation (re-RT) (54 Gy/30 fractions and 30 Gy/10 fractions) was applied in two patients, and one patient received bevacizumab treatment. All three patients succumbed with a median survival of 7.5 months (range 4.0–58 months). Conclusions Radiation-induced glioma of the pons is a rare and serious complication occurring in patients previously treated by RT for childhood CP. This secondary tumor is uniformly associated with a dramatic course regardless of the treatment modalities and resources. This highlights the need for clinical vigilance and further research to prevent it.