Leptomeningeal disease and neurologic death after surgical resection and radiosurgery for brain metastases: A multi-institutional analysis
| Autor: | William G. Breen, Zachary K. Vaslow, Paul D. Brown, Anthony L. Asher, Kirtesh R. Patel, Walter J. Curran, S. Marcrom, John B. Fiveash, Robert H. Press, Lauren M Foster, Paul M. Foreman, Scott G. Soltys, Inga S. Grills, Krishan R. Jethwa, Roshan S. Prabhu, M. Manning, Brandon E. Turner, Zachary S. Buchwald, Jessica D. Arden, Stuart H. Burri |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Surgical resection
lcsh:Medical physics. Medical radiology. Nuclear medicine medicine.medical_specialty medicine.medical_treatment Radiography lcsh:R895-920 lcsh:RC254-282 Radiosurgery 030218 nuclear medicine & medical imaging Lesion 03 medical and health sciences 0302 clinical medicine medicine Research Letter LEPTOMENINGEAL DISEASE Radiology Nuclear Medicine and imaging Cause of death business.industry Odds ratio lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Oncology 030220 oncology & carcinogenesis Cohort Radiology medicine.symptom business |
| Zdroj: | Advances in Radiation Oncology, Vol 6, Iss 2, Pp 100644-(2021) Advances in Radiation Oncology |
| ISSN: | 2452-1094 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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