Tos Salem M, Hajikarimloo Bardia, Mantziaris Georgios, Ishaque Mariam, Ramanathan Purushotham, Schlesinger David, Sheehan Jason P
Department of Neurosurgery, University of Virginia, Box 800212, Charlottesville, VA, 22908, USA.
Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
Acta Neurochir (Wien). 2025 Mar 14;167(1):73. doi: 10.1007/s00701-025-06478-8.
Leukoencephalopathy is the most prevalent and delayed adverse radiation effect (ARE) after intracranial radiotherapy (RT). Patients with leukoencephalopathy experience some levels of cognitive and neurological dysfunction. This investigation assessed the frequency and clinical outcomes of leukoencephalopathy following stereotactic radiosurgery (SRS) alone or SRS following whole-brain radiation therapy (WBRT) in breast cancer brain metastasis.
We retrospectively evaluated the data of brain metastases from breast cancer individuals who underwent SRS between 2007 and 2022. MRI sequences were examined to assess white matter changes and tumor control.
Among 125 patients with 1,077 brain metastases, 58 (46.4%) patients received WBRT prior to SRS. By year 3, 23.4% of WBRT + SRS patients developed high-grade leukoencephalopathy (grades 2-3) compared to 5.7% in the SRS-only group (p < 0.001). In univariate analyses, significant predictors of high-grade leukoencephalopathy included prior WBRT (HR: 18.4, p = 0.005), cumulative integral dose > 3 J (HR: 4.17, p = 0.029), and the total number of lesions (HR: 1.22, p < 0.001). In multivariate analyses, prior WBRT (HR: 11.1, p = 0.022) and total lesions (HR: 1.14, p = 0.037) remained significant predictors.
Our findings demonstrated that WBRT plus SRS is associated with higher leukoencephalopathy rates than SRS alone. This underscores the importance of carefully weighing the benefits and risks of different ionizing radiation approaches in the management of brain metastasis from breast cancer.
白质脑病是颅内放疗（RT）后最常见且出现较晚的迟发性放射效应（ARE）。白质脑病患者会出现一定程度的认知和神经功能障碍。本研究评估了单纯立体定向放射外科治疗（SRS）或全脑放射治疗（WBRT）后行SRS治疗乳腺癌脑转移患者的白质脑病发生率及临床结局。
我们回顾性评估了2007年至2022年间接受SRS治疗的乳腺癌脑转移患者的数据。检查MRI序列以评估白质变化和肿瘤控制情况。
在125例有1077个脑转移灶的患者中，58例（46.4%）患者在SRS前接受了WBRT。到第3年，WBRT + SRS组23.4%的患者发生了高级别白质脑病（2 - 3级），而单纯SRS组为5.7%（p < 0.001）。在单因素分析中，高级别白质脑病的显著预测因素包括既往WBRT（HR：18.4，p = 0.005）、累积积分剂量> 3 J（HR：4.17，p = 0.029）和病灶总数（HR：1.22，p < 0.001）。在多因素分析中，既往WBRT（HR：11.1，p = 0.022）和病灶总数（HR：1.14，p = 0.037）仍然是显著的预测因素。
我们的研究结果表明，WBRT联合SRS比单纯SRS导致白质脑病的发生率更高。这凸显了在乳腺癌脑转移治疗中仔细权衡不同电离辐射方法的利弊的重要性。
