Tumor control and motor function in patients with metastases located in the primary motor cortex after stereotactic radiosurgery.

Objectives: To characterize the outcomes of patients with brain metastases located in the motor cortex after stereotactic radiosurgery (SRS).

Methods: A retrospective review was performed of 1151 patients with brain metastases who underwent Gamma Knife SRS between 2012 and 2020. Outcome measures were motor function, radiographic changes, adverse radiation effect (ARE), disease-free progression, and overall survival time.

Results: In total, 130 (11.3%) patients presented with 185 primary motor cortex tumors. Non-small cell lung cancer and breast cancer were the most common primary malignancies. The median age at SRS was 63 years, and 91 (70%) patients were female. The median tumor volume was 0.07 cm (range: 0.003-22.21) and the median margin dose prescribed was 16 Gy (range 12-20 Gy). The overall survival after SRS at 3, 6, and 12 months was 85%, 66%, and 42%, respectively. At the presentation to SRS, 105 (81%) patients had no motor deficit. Twenty-five (19%) patients had mild to moderate weakness, among which 14 patients improved in strength; 3 patients developed transient new deficits. In 119 patients with documented motor strength after SRS, 96 patients (80.7%) showed stable motor function from baseline. One patient developed worsening symptoms and required repeated SRS. Overall, 7 patients had repeat SRS due to tumor progression. The overall local tumor control rate was 94.6%, at a median follow-up of 9.4 months. Pre-SRS peritumoral edema was present in 78 patients, with 62.8% showing stable or reduced edema.

Conclusions: SRS provided effective and safe tumor control in patients with metastases located in the motor cortex including patients with peritumoral edema. Contralateral motor function was stabilized or improved in most patients, though the median follow-up of 9.4 months limits long-term interpretation.