Metastases in the Pineal Region: A Systematic Review of Clinical Features, Management Strategies, and Survival Outcomes.

BACKGROUND: Pineal region metastases are rare but often cause severe neurological deficits. Surgical resection and chemoradiotherapy can provide therapeutic benefit. We investigated the literature to analyze clinical characteristics, management strategies, and survival of adult patients with pineal region metastases. METHODS: PubMed, EMBASE, Scopus, and Cochrane were searched following the PRISMA guidelines, including studies reporting clinical outcomes of patients with pineal region metastases. Clinical presentation, management, and survival were reviewed. RESULTS: We included 31 studies comprising 47 patients. Lung cancer (29.8%) and carcinomas-of-unknown-origin (14.9%) were the most frequent primary tumors. In 48.9% patients, symptomatic pineal metastases preceded primary tumor diagnosis. Headache (67.4%) and confusion (46.5%) were the most common symptoms. Parinaud's syndrome (46.5%) and hydrocephalus (87.2%) were noted. Biopsy (65.9%) was preferred over resection (34.1%), while utilized shunting strategies were endoscopic third ventriculostomy (43.9%) and ventriculoperitoneal (26.8%). Eleven patients (32.3%) received adjuvant chemotherapy and 32 (68%) received radiotherapy. Post-treatment improvement in symptoms (56.6%) and hydrocephalus (80.5%) were noted. In patients who received adjuvant chemotherapy/radiotherapy, significant improvement in post-treatment performance status occurred with both biopsy (P<0.001) and resection (P=0.007). No survival differences were reported between surgery and biopsy (P=0.912), nor between complete and partial resection (P=0.220). Overall survival was neither influenced by surgical approach (P=0.157), nor by shunting strategy (P=0.822). Mean follow-up was 8 months, and median overall survival 3 months. Only two cases (4.8%) of pineal metastasis demonstrated recurrence. CONCLUSION: Pineal region metastases carry significant morbidity. Biopsy or surgical resection, combined with adjuvant chemotherapy/radiotherapy and/or shunting, may significantly improve performance status.