Crouzen Jeroen A, Petoukhova Anna L, Hakstege Martijn, van Schaik Elise E M W, Nandoe Tewarie Rishi D S, Nabuurs Rob J A, Vos Maaike J, Kerkhof Melissa, van der Vaart Thijs, Koekkoek Johan A F, Hagenbeek Rogier E, Yildirim Fatih M, Wiltink Lisette M, van der Voort van Zyp Noëlle C M G, Kiderlen Mandy, Broekman Marike L D, Mast Mirjam E, Zindler Jaap D
Department of Radiation Oncology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
Department of Medical Physics, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
Cancers (Basel). 2025 May 3;17(9):1557. doi: 10.3390/cancers17091557.
BACKGROUND/OBJECTIVES: Neurosurgical resection is the standard treatment for large brain metastases (BMs). Postoperative stereotactic radiotherapy (SRT) is used to reduce local recurrence (LR) but does not always prevent leptomeningeal disease (LMD). This study aims to analyze patterns of tumor recurrence and to identify opportunities for the further improvement of treatment efficacy.
We included 147 patients who underwent resection and SRT for BMs. The distance between the resection cavity target volume and the new tumor growth was calculated. Cox regression analyses were used to assess associations of LMD with various patient characteristics.
Median survival after postoperative SRT was 14 months (IQR 6-30) with a 3-year actuarial survival rate of 21%. LR occurred in 20/147 patients (14%). After total resection, LR occurred in 21% of patients after 3 years of follow-up compared to 36% after subtotal resection. Marginal LR occurred in 5/147 patients (3%). LMD was found in 21/147 patients (14%; 3-year actuarial rate, 26%), and it was found more commonly in patients with resected cerebellar metastases (23%; 3-year actuarial rate, 46%) compared to those with cerebral metastases (11%; 3-year actuarial rate 17%) (HR 2.54, 95% CI 1.07-6.04, = 0.034).
This study examined patterns of recurrence after postoperative radiotherapy and its implications for radiation dose, radiation field size, and treatment sequence. Local control was high after total resection. Radiation field size appeared adequate given the low incidence of marginal recurrences. Patients with cerebellar metastases showed an increased risk of LMD, underscoring the need for preventive measures, particularly preoperative SRT.
背景/目的：神经外科手术切除是治疗大脑大转移瘤（BMs）的标准方法。术后立体定向放射治疗（SRT）用于降低局部复发（LR），但并不总是能预防软脑膜疾病（LMD）。本研究旨在分析肿瘤复发模式，并确定进一步提高治疗效果的机会。
我们纳入了147例接受BMs切除和SRT的患者。计算切除腔靶体积与新肿瘤生长之间的距离。采用Cox回归分析评估LMD与各种患者特征的关联。
术后SRT后的中位生存期为14个月（四分位间距6 - 30），3年精算生存率为21%。147例患者中有20例（14%）发生LR。全切除后，随访3年21%的患者发生LR，次全切除后为36%。147例患者中有5例（3%）发生边缘LR。147例患者中有21例（14%；3年精算率，26%）发现LMD，与脑转移患者（11%；3年精算率17%）相比，小脑转移瘤切除患者中更常见（23%；3年精算率，46%）（风险比2.54，95%可信区间1.07 - 6.04，P = 0.034）。
本研究检查了术后放疗后的复发模式及其对放射剂量、放射野大小和治疗顺序的影响。全切除后局部控制良好。鉴于边缘复发发生率低，放射野大小似乎足够。小脑转移患者发生LMD的风险增加，强调需要采取预防措施，特别是术前SRT。
