Motor and Sensory Outcomes in Rolandic and Perirolandic Tumors Treated with Stereotactic Radiosurgery and Surgery Versus Stereotactic Radiosurgery Alone

Introduction: Resection of tumors located at or near the central sulcus (rolandic or perirolandic lesions) pose an increased risk of treatment-related motor and sensory deficits. To date, only one other study has compared the motor and sensory outcomes of patients with rolandic or perirolandic tumors treated with surgery plus stereotactic radiosurgery (SRS) versus SRS alone.

Methods: This retrospective study evaluated medical records of 72 patients with rolandic or perirolandic brain tumors; 41 underwent surgery plus SRS and 29 received SRS alone at Emory Healthcare between 2009 and 2020.

Results: The mean age was 54 with 50% female. Patients with metastatic tumors were more likely to receive SRS alone (p < 0.001). Patients with multiple tumors were more likely to receive SRS alone (p < 0.001). Larger tumors were more likely to be treated by SRS plus surgery (p < 0.001). There were no significant differences in 3-month or 12-month OS or PFS between treatment groups (OS log-rank p = 0.3741; PFS log-rank = 0.1776). OS at 3 months and 12 months was 93.1% and 75.9%, respectively, for SRS alone and 92.5% and 85.0%, respectively, for SRS plus surgery. Patients that received SRS plus surgery were more likely to have a KPS less than or equal to 70 post-operatively (OR: 2.53; p-value = 0.035). Patients that received SRS plus surgery were more likely to have a motor score less than or equal to 4 in the left upper extremity post-operatively (OR: 5.53; p-value = 0.034). Patients that received SRS plus surgery were less likely to have improvement in sensory symptoms post-operatively (OR: 0.23; p-value = 0.020).

Conclusion : There was no significant difference in OS or PFS. However, receiving SRS plus surgery resulted in lower KPS, a trend towards lower post-operative motor scores, and a decreased likelihood of improvement in sensory symptoms.