SURG-06. Metastases in the pineal region: a systematic review of clinical features, treatment strategies and survival outcomes

BACKGROUND: Pineal region metastases are rare but often lead to severe neurological deficits. Surgical resection may play a therapeutic role. METHODS: We searched PubMed, EMBASE, Scopus, and Cochrane according to PRISMA guidelines. Studies reporting clinical outcomes data of patients with pineal region metastases were included. Clinical characteristics, management strategies, and survival data were reviewed. RESULTS: We included 30 studies comprising 46 patients. The median age at diagnosis was 58 years (range 27–82). Lung cancer (30.4%) and carcinomas of unknown origin (15.2%) were the most frequent primary tumors. In 50% of patients, symptomatic pineal metastases preceded primary tumor diagnosis. Headache (66.7%) and confusion (45.2%) were the most common presenting symptoms. Parinaud’s syndrome (47.6%) and hydrocephalus (87%) were commonly noted. Biopsy (67.4%) was preferred over surgical resection (32.6%). The most common CSF diversion protocols were endoscopic third ventriculostomy (45%) and ventriculoperitoneal shunting (27.5%). Eleven patients received adjuvant chemotherapy and 31 underwent radiotherapy. At post-treatment follow-up, symptomatic improvement (55.2%) and hydrocephalus reduction (80%) were described. Post-treatment performance status scores were statistically superior that pre-treatment scores for patients undergoing biopsy (P<0.001) and tumor resection (P=0.007) coupled with adjuvant chemo/radiotherapy. Mean follow-up was 8 months, and median overall survival was 3 months. Only two cases (4.8%) of pineal metastases recurrence were reported, and median progression-free survival was 3 months. In patients receiving adjuvant chemo/radiotherapy, no survival differences were reported between surgery and biopsy (P=0.912), nor between gross-total and subtotal resection (P=0.220). Overall survival was neither correlated with surgical approach (P=0.157), nor with CSF diversion protocol (P=0.822). CONCLUSION: Pineal region metastases can severely impair clinical status. Biopsy or surgical resection may significantly improve symptoms and baseline performance status when combined with adjuvant chemo/radiotherapy and CSF diversion.