title: Leptomeningeal disease following stereotactic radiosurgery for brain metastases from breast cancer.
abstract: Leptomeningeal disease (LMD) is a highly aggressive and usually rapidly fatal condition. The purpose of this study is to identify clinical factors that can serve to predict for LMD at the time of stereotactic radiosurgery (SRS) for brain metastases from breast carcinoma. We conducted a retrospective review of patients with brain metastases from breast cancer treated with SRS from 1995 to 2014 at our institution. Clinical, radiographic, and dosimetric data were collected. LMD was diagnosed by cerebrospinal fluid (CSF) cytology or MRI demonstrating CSF seeding. Comparative statistical analyses were conducted using Cox proportional hazards regression, binary logistic regression, and/or log-rank test. 126 patients met inclusion criteria. Eighteen patients (14 %) developed LMD following SRS. From the time of SRS, the actuarial rate of LMD at 12 months from diagnosis of brain metastasis was 9 % (11 patients). Active disease in the chest at the time of SRS was associated with development of LMD (p = 0.038). Factors including receptor status, tumor size, number of intra-axial tumors, cystic tumor morphology, prior WBRT, active bone metastases, and active liver metastases were not significantly associated with the development of LMD. In patients with brain metastasis from breast cancer that undergo SRS, there is a relatively low rate of LMD. We found that while tumor hormonal status, bone metastases, and hepatic metastases were not associated with the development of LMD, active lung metastases at SRS was associated with LMD. Further research may help to delineate a causative relationship between metastatic lung disease and LMD.
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, P.O. Box 800383, Charlottesville, VA, 22908, USA. daniel.trifiletti@gmail.com.
authors.forename: Daniel M
authors.identifier: http://orcid.org/0000-0002-9150-2916
authors.initials: DM
authors.lastname: Trifiletti
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, P.O. Box 800383, Charlottesville, VA, 22908, USA.
authors.forename: Kara D
authors.initials: KD
authors.lastname: Romano
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, P.O. Box 800383, Charlottesville, VA, 22908, USA.
authors.forename: Kelli A
authors.initials: KA
authors.lastname: Reardon
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, P.O. Box 800383, Charlottesville, VA, 22908, USA.|Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000209:etiology*; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*; D055815:Young Adult
keywords: Brain metastases; Breast cancer; Leptomeningeal disease; Radiosurgery