PURPOSE: We sought to determine the risk of leptomeningeal disease (LMD) in patients treated with stereotactic radiosurgery (SRS) targeting the postsurgical resection cavity of a brain metastasis, deferring whole-brain radiation therapy (WBRT) in all patients. METHODS AND MATERIALS: We retrospectively reviewed 175 brain metastasis resection cavities in 165 patients treated from 1998 to 2011 with postoperative SRS. The cumulative incidence rates, with death as a competing risk, of LMD, local failure (LF), and distant brain parenchymal failure (DF) were estimated. Variables associated with LMD were evaluated, including LF, DF, posterior fossa location, resection type (en-bloc vs piecemeal or unknown), and histology (lung, colon, breast, melanoma, gynecologic, other). RESULTS: With a median follow-up of 12 months (range, 1-157 months), median overall survival was 17 months. Twenty-one of 165 patients (13%) developed LMD at a median of 5 months (range, 2-33 months) following SRS. The 1-year cumulative incidence rates, with death as a competing risk, were 10% (95% confidence interval [CI], 6%-15%) for developing LF, 54% (95% CI, 46%-61%) for DF, and 11% (95% CI, 7%-17%) for LMD. On univariate analysis, only breast cancer histology (hazard ratio, 2.96) was associated with an increased risk of LMD. The 1-year cumulative incidence of LMD was 24% (95% CI, 9%-41%) for breast cancer compared to 9% (95% CI, 5%-14%) for non-breast histology (P=.004). CONCLUSIONS: In patients treated with SRS targeting the postoperative cavity following resection, those with breast cancer histology were at higher risk of LMD. It is unknown whether the inclusion of whole-brain irradiation or novel strategies such as preresection SRS would improve this risk or if the rate of LMD is inherently higher with breast histology.
PURPOSE: We sought to determine the risk of leptomeningeal disease (LMD) in patients treated with stereotactic radiosurgery (SRS) targeting the postsurgical resection cavity of a brain metastasis, deferring whole-brain radiation therapy (WBRT) in all patients. METHODS AND MATERIALS: We retrospectively reviewed 175 brain metastasis resection cavities in 165 patients treated from 1998 to 2011 with postoperative SRS. The cumulative incidence rates, with death as a competing risk, of LMD, local failure (LF), and distant brain parenchymal failure (DF) were estimated. Variables associated with LMD were evaluated, including LF, DF, posterior fossa location, resection type (en-bloc vs piecemeal or unknown), and histology (lung, colon, breast, melanoma, gynecologic, other). RESULTS: With a median follow-up of 12 months (range, 1-157 months), median overall survival was 17 months. Twenty-one of 165 patients (13%) developed LMD at a median of 5 months (range, 2-33 months) following SRS. The 1-year cumulative incidence rates, with death as a competing risk, were 10% (95% confidence interval [CI], 6%-15%) for developing LF, 54% (95% CI, 46%-61%) for DF, and 11% (95% CI, 7%-17%) for LMD. On univariate analysis, only breast cancer histology (hazard ratio, 2.96) was associated with an increased risk of LMD. The 1-year cumulative incidence of LMD was 24% (95% CI, 9%-41%) for breast cancer compared to 9% (95% CI, 5%-14%) for non-breast histology (P=.004). CONCLUSIONS: In patients treated with SRS targeting the postoperative cavity following resection, those with breast cancer histology were at higher risk of LMD. It is unknown whether the inclusion of whole-brain irradiation or novel strategies such as preresection SRS would improve this risk or if the rate of LMD is inherently higher with breast histology.
Authors: Kirtesh R Patel; Stuart H Burri; Danielle Boselli; James T Symanowski; Anthony L Asher; Ashley Sumrall; Robert W Fraser; Robert H Press; Jim Zhong; Richard J Cassidy; Jeffrey J Olson; Walter J Curran; Hui-Kuo G Shu; Ian R Crocker; Roshan S Prabhu Journal: J Neurooncol Date: 2016-12-20 Impact factor: 4.130
Authors: Jim Zhong; Matthew J Ferris; Jeffrey Switchenko; Robert H Press; Zachary Buchwald; Jeffrey J Olson; Bree R Eaton; Walter J Curran; Hui-Kuo G Shu; Ian R Crocker; Kirtesh R Patel Journal: Pract Radiat Oncol Date: 2017-04-26
Authors: Tavish Nanda; Andrew Yaeh; Cheng-Chia Wu; Ashish Jani; Shumaila Saad; Yasir H Qureshi; Keith A Cauley; Jeraldine Lesser; Simon K Cheng; Steven R Isaacson; Michael B Sisti; Jeffrey N Bruce; Guy M McKhann; Sameer A Sheth; Andrew B Lassman; Tony J C Wang Journal: J Neurooncol Date: 2017-11-23 Impact factor: 4.130
Authors: Kamran A Ahmed; Jessica M Freilich; Yazan Abuodeh; Nicholas Figura; Neha Patel; Siriporn Sarangkasiri; Prakash Chinnaiyan; Hsiang-Hsuan Michael Yu; Arnold B Etame; Nikhil G Rao Journal: J Neurooncol Date: 2014-03-07 Impact factor: 4.130
Authors: Thomas M Churilla; Imran H Chowdhury; Elizabeth Handorf; Laurence Collette; Sandra Collette; Yanqun Dong; Brian M Alexander; Martin Kocher; Riccardo Soffietti; Elizabeth B Claus; Stephanie E Weiss Journal: JAMA Oncol Date: 2019-02-01 Impact factor: 31.777