Risk of Leptomeningeal Disease in Patients Treated With Stereotactic Radiosurgery Targeting the Postoperative Resection Cavity for Brain Metastases
Risk of Leptomeningeal Disease in Patients Treated With Stereotactic Radiosurgery Targeting the Postoperative Resection Cavity for Brain Metastases
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DOI：
10.1016/j.ijrobp.2013.07.034
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发表时间：
2013-11-15
影响因子：
7
通讯作者：
Soltys, Scott G.
中科院分区：
文献类型：
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作者：
Atalar, Banu;Modlin, Leslie A.;Soltys, Scott G.
目的：我们试图确定以脑转移术后切除腔为目标的立体定向放射手术（SRS）治疗的患者发生轻脑膜病（LMD）的风险，并推迟所有患者的全脑放射治疗（WBRT）。方法与材料：回顾性分析1998年至2011年165例采用SRS手术治疗的175个脑转移腔。以死亡为竞争风险，估计LMD、局部功能衰竭（LF）和远端脑实质功能衰竭（DF）的累积发病率。评估与LMD相关的变量，包括LF、DF、后窝位置、切除类型（整体vs零碎或未知）和组织学（肺、结肠、乳腺、黑色素瘤、妇科、其他）。结果：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。以死亡为竞争风险的1年累积发病率为，发展中的LF为10%(95%可信区间[CI]， 6%-15%)， DF为54% (95% CI, 46%-61%)， LMD为11% （95% CI, 7%-17%）。在单因素分析中，只有乳腺癌组织学（风险比2.96）与LMD风险增加相关。乳腺癌的1年累积LMD发病率为24% (95% CI, 9%-41%)，而非乳腺组织学的LMD发病率为9% (95% CI, 5%-14%) （P= 0.004）。结论：在手术切除后针对术后腔进行SRS治疗的患者中，具有乳腺癌组织学的患者发生LMD的风险更高。目前尚不清楚是否包括全脑照射或诸如切除前SRS之类的新策略会改善这种风险，或者乳房组织学上LMD的发生率是否固有地更高。(C) 2013爱思唯尔公司
Purpose: 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.Methods and Materials: 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).Results: 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).Conclusions: 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. (C) 2013 Elsevier Inc.