1Departments of Chest Medicine.
2School of Medicine, National Yang Ming Chiao Tung University, Taipei.
J Neurosurg. 2022 Dec 9;139(2):385-392. doi: 10.3171/2022.11.JNS221888. Print 2023 Aug 1.
Stereotactic radiosurgery (SRS) is an effective treatment for brain metastases (BMs) in patients with non-small cell lung cancer (NSCLC). However, factors associated with the development of post-SRS leptomeningeal metastasis (LM) remain unclear. The authors analyzed the incidence and risk factors of LM development in patients with NSCLC and BMs after SRS and examined the survival outcomes and prognostic factors after LM development.
This retrospective study included patients with NSCLC treated with SRS for MRI-diagnosed BM from 2002 to 2021. The authors recorded various clinical and demographic data, including age, sex, tumor histology, molecular profile of tumors, extracranial disease status, previous craniotomy, Karnofsky Performance Status, systemic treatments, tumor volume, and number of BMs. The management and survival outcomes after LM diagnosis were also recorded.
LM developed in 13.7% of patients with NSCLC and BMs after SRS treatment. Large initial tumor volume and more than 5 BM lesions, but not EGFR mutation status and post-SRS treatment, were associated with LM development after SRS. Multivariate analysis revealed that chemotherapy and targeted therapy after LM were associated with better survival in patients with LM after SRS.
This study is the first to evaluate the risk factors for LM in a relatively large cohort of patients with NSCLC after SRS. In patients with BMs harboring risk factors for subsequent LM, such as initial tumor volume and number of metastatic lesions, aggressive therapies with high CNS penetrating ability should be considered.
立体定向放射外科（SRS）是治疗非小细胞肺癌（NSCLC）患者脑转移瘤（BMs）的有效方法。然而，SRS 后发生脑膜转移（LM）的相关因素仍不清楚。作者分析了 NSCLC 伴 BM 患者 SRS 后 LM 发展的发生率和危险因素，并探讨了 LM 发展后的生存结局和预后因素。
本回顾性研究纳入了 2002 年至 2021 年因 MRI 诊断为 BM 而行 SRS 治疗的 NSCLC 患者。作者记录了各种临床和人口统计学数据，包括年龄、性别、肿瘤组织学、肿瘤分子谱、颅外疾病状态、既往开颅术、卡氏功能状态评分、全身治疗、肿瘤体积和 BM 数量。还记录了 LM 诊断后的管理和生存结局。
在 SRS 治疗后的 NSCLC 和 BMs 患者中，13.7%发生了 LM。初始肿瘤体积较大和超过 5 个 BM 病变与 SRS 后发生 LM 有关，而 EGFR 突变状态和 SRS 后治疗与 LM 发生无关。多变量分析显示，LM 后进行化疗和靶向治疗与 LM 后 SRS 患者的生存改善相关。
本研究首次在相对较大的 NSCLC 患者 SRS 后队列中评估了 LM 的危险因素。对于存在随后发生 LM 风险因素（如初始肿瘤体积和转移病灶数量）的 BMs 患者，应考虑采用具有高中枢神经系统穿透能力的积极治疗方法。
