Robert H Press1, Chao Zhang2, Mudit Chowdhary3, Roshan S Prabhu4, Matthew J Ferris1, Karen M Xu1, Jeffrey J Olson5, Bree R Eaton1, Hui-Kuo G Shu1, Walter J Curran1, Ian R Crocker1, Kirtesh R Patel6. 1. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia. 2. Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia. 3. Department of Radiation Oncology, Rush University, Chicago, Illinois. 4. Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, North Carolina. 5. Department of Neurological Surgery, Emory University, Atlanta, Georgia. 6. Department of Therapeutic Radiology, Smilow Cancer Center, Yale University, New Haven, Connecticut.
Abstract
BACKGROUND: Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE: To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS: One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS: Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION: Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.
BACKGROUND:Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE: To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS: One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS: Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION:Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.
Authors: Timothy K Nguyen; Arjun Sahgal; Jay Detsky; Eshetu G Atenafu; Sten Myrehaug; Chia-Lin Tseng; Zain Husain; Chris Heyn; Pejman Maralani; Mark Ruschin; James Perry; Hany Soliman Journal: Neuro Oncol Date: 2020-01-11 Impact factor: 12.300
Authors: Desmond A Brown; Victor M Lu; Benjamin T Himes; Terry C Burns; Alfredo Quiñones-Hinojosa; Kaisorn L Chaichana; Ian F Parney Journal: Clin Exp Metastasis Date: 2020-01-16 Impact factor: 5.150
Authors: Ishaan Ashwini Tewarie; Charissa A C Jessurun; Alexander F C Hulsbergen; Timothy R Smith; Rania A Mekary; Marike L D Broekman Journal: Neurooncol Adv Date: 2021-11-10