Hong Ji Hyun, Lee Jieun, Shin Kabsoo, Choi Byung-Ock, Park Jae Sung, Ahn Stephen, Song Jin-Ho
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medi-cine, The Catholic University of Korea, Seoul, Republic of Korea.
In Vivo. 2025 Mar-Apr;39(2):1094-1103. doi: 10.21873/invivo.13914.
BACKGROUND/AIM: This study aimed to identify the incidence and risk factors for leptomeningeal seeding (LMS) in patients with breast cancer following brain metastasis resection and radiotherapy (RT) and to determine potential candidates for preoperative stereotactic radiosurgery (SRS).
Between 2012 and 2022, 33 patients with breast cancer underwent surgical resection and postoperative RT for newly detected brain metastases. Twenty-one patients received whole-brain RT, while 12 patients were treated with SRS. Survival and incidence of LMS development were retrospectively analyzed. Several risk factors for the development of LMS were identified.
After a median follow-up of 25.3 months, the 1- and 3-year overall survival (OS) rates were 81.2% and 58.1%, respectively. Development of LMS was the only significant factor affecting OS in multivariate analysis (Hazard ratio=3.08). Significant risk factors for LMS included age ≤45 years, triple-negative breast cancer (TNBC), and piecemeal resection. The 1-year LMS risk was 85.7% for younger patients, 46.2% for those with TNBC or piecemeal resection, and 11.1% for older patients without TNBC undergoing en-bloc resection.
Patients with breast cancer brain metastases who were ≤45 years old, had TNBC, or underwent piecemeal resection were at high risk of developing LMS, regardless of the postoperative RT technique used. Patients with these risk factors are essential candidates for alternative treatment approaches, such as preoperative SRS.
背景/目的：本研究旨在确定乳腺癌患者脑转移瘤切除术后放疗（RT）后脑膜播散（LMS）的发生率和危险因素，并确定术前立体定向放射外科（SRS）的潜在候选者。
2012年至2022年期间，33例乳腺癌患者因新发现的脑转移瘤接受了手术切除及术后放疗。21例患者接受了全脑放疗，12例患者接受了SRS治疗。对LMS发生的生存率和发生率进行回顾性分析。确定了LMS发生的几个危险因素。
中位随访25.3个月后，1年和3年总生存率（OS）分别为81.2%和58.1%。在多变量分析中，LMS的发生是影响OS的唯一显著因素（风险比=3.08）。LMS的显著危险因素包括年龄≤45岁、三阴性乳腺癌（TNBC）和分块切除。年轻患者的1年LMS风险为85.7%，TNBC或分块切除患者为46.2%，年龄较大且未患TNBC且接受整块切除的患者为11.1%。
年龄≤45岁、患有TNBC或接受分块切除的乳腺癌脑转移患者发生LMS的风险较高，无论采用何种术后放疗技术。具有这些危险因素的患者是替代治疗方法（如术前SRS）的重要候选者。
