Leptomeningeal disease and neurologic death after surgical resection and radiosurgery for brain metastases: A multi-institutional analysis
Year: 2021
Type: article
Study design: Observational Study
Abstract: Purpose Postoperative stereotactic radiosurgery (SRS) is associated with up to 30% risk of subsequent leptomeningeal disease (LMD). Radiographic patterns of LMD (classical sugarcoating [cLMD] vs. nodular [nLMD]) in this setting has been shown to be prognostic. However, the association of these findings with neurologic death (ND) is not well described. Methods and Materials The records for patients with brain metastases who underwent surgical resection and adjunctive SRS to 1 lesion (SRS to other intact lesions was allowed) and subsequently developed LMD were combined from 7 tertiary care centers. Salvage radiation therapy (RT) for LMD was categorized according to use of whole-brain versus focal cranial RT. Results The study cohort included 125 patients with known cause of death. The ND rate in these patients was 79%, and the rate in patients who underwent LMD salvage treatment (n = 107) was 76%. Univariate logistic regression demonstrated radiographic pattern of LMD (cLMD vs. nLMD, odds ratio: 2.9; P = .04) and second LMD failure after salvage treatment (odds ratio: 3.9; P = .02) as significantly associated with ND. The ND rate was 86% for cLMD versus 68% for nLMD. Whole-brain RT was used in 95% of patients with cLMD and 52% with nLMD. In the nLMD cohort (n = 58), there was no difference in ND rate based on type of salvage RT (whole-brain RT: 67% vs. focal cranial RT: 68%, P = .92). Conclusions LMD after surgery and SRS for brain metastases is a clinically significant event with high rates of ND. Classical LMD pattern (vs. nodular) and second LMD failure after salvage treatment were significantly associated with a higher risk of ND. Patients with nLMD treated with salvage focal cranial RT did not have higher ND rates compared with WBRT. Methods to decrease LMD and the subsequent high risk of ND in this setting warrant further investigation.
Source: Advances in Radiation Oncology
Authors: Roshan S. Prabhu, Brandon E. Turner, Anthony L. Asher, Samuel R. Marcrom, John B. Fiveash, Paul M. Foreman, Robert H. Press, Zachary S. Buchwald, Walter J. Curran, Kirtesh R. Patel, William G. Breen, Paul D. Brown, Krishan R. Jethwa, Inga S. Grills, Jessica D. Arden, Lauren M. Foster, Matthew A. Manning, Zachary K. Vaslow, Stuart H. Burri, Scott G. Soltys
Institutions: Levine Cancer Institute, Southeast Radiation Oncology Group, Stanford Medicine, Stanford University, Carolina Neurosurgery and Spine Associates, University of Alabama at Birmingham, New York Proton Center, Winship Cancer Institute, Kaiser Permanente, Mayo Clinic, Yale University, Beaumont Health, Cone Health
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W3118936543