Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery. Issue 5 (November 2019)

• Record Type: Journal Article
• Authors: Press, Robert H; Zhang, Chao; Chowdhary, Mudit; Prabhu, Roshan S; Ferris, Matthew J; Xu, Karen M; Olson, Jeffrey J; Eaton, Bree R; Shu, Hui‐Kuo G; Curran, Walter J; Crocker, Ian R; Patel, Kirtesh R
• Is Part Of: Neurosurgery. Volume 85:Issue 5(2019)
• Publication Date: 2019-11
• Subjects: Cyst fluid -- Intracranial hemorrhages -- Magnetic resonance imaging -- Meningeal neoplasms -- Neoplasm metastasis -- Radiosurgery; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy436
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: : Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE: : To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS: : One hundred thirty‐four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan‐Meier method. RESULTS: : Median imaging follow‐up was 14.2 mo (range 2.5‐132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12‐ and 24‐mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION: : Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.