Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey.
Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):713-8. doi: 10.1016/j.ijrobp.2013.07.034. Epub 2013 Sep 18.
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.
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).
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).
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.
我们旨在确定在所有患者中延迟全脑放疗（WBRT）的情况下，接受立体定向放射外科（SRS）治疗脑转移瘤术后切除腔的患者发生脑膜疾病（LMD）的风险。
我们回顾性分析了 1998 年至 2011 年间 165 例接受术后 SRS 治疗的 175 个脑转移瘤切除腔的患者。使用死亡作为竞争风险，估计 LMD、局部失败（LF）和远处脑实质失败（DF）的累积发生率。评估了与 LMD 相关的变量，包括 LF、DF、后颅窝位置、切除类型（整块切除与部分切除或未知）和组织学（肺、结肠、乳腺、黑素瘤、妇科、其他）。
中位随访 12 个月（范围 1-157 个月），中位总生存期为 17 个月。165 例患者中有 21 例（13%）在 SRS 后中位 5 个月（范围 2-33 个月）发生 LMD。以死亡为竞争风险，1 年累积发生率分别为 LF 10%（95%CI，6%-15%）、DF 54%（95%CI，46%-61%）和 LMD 11%（95%CI，7%-17%）。单因素分析显示，仅乳腺癌组织学（风险比，2.96）与 LMD 风险增加相关。乳腺癌的 1 年累积 LMD 发生率为 24%（95%CI，9%-41%），而非乳腺癌组织学为 9%（95%CI，5%-14%）（P=0.004）。
在接受针对切除术后腔的 SRS 治疗的患者中，乳腺癌组织学患者发生 LMD 的风险更高。尚不清楚包括全脑照射或新的策略（如术前 SRS）是否会降低这种风险，或者 LMD 的发生率是否固有地更高与乳腺癌的组织学有关。
