Patient outcomes of whole brain radiotherapy for brain metastases versus leptomeningeal metastases: A retrospective study.
OBJECTIVE
Important factors typically associated with prognosis in brain metastases include Karnofsky performance status (KPS), extracranial or cerebellar localization and combination chemotherapy. However, few studies investigated the prognostic role of leptomeningeal metastases (LM) following whole brain radiotherapy (WBRT). On the basis of our experience suggesting better survival of asymptomatic patients with LM than those with brain metastases, we herein evaluated LM as a prognostic factor after WBRT.


METHODS
Medical records of 206 patients (median age, 65 years) who received WBRT in 2007-2015 were retrospectively reviewed. The two most common cancers were of lung, breast origin in 78.5%, 10%, patients, respectively. Patients received parallel-opposed WBRT, with a dose of 20-40 Gy. Additional doses of 9-12 Gy were used in patients who were operated on or had single metastases. Overall survival (OS) was determined, and clinical parameters including age, KPS, symptoms, radiation dose, dose per fraction, type of metastasis, extracranial metastases, primary status and surgery plus WBRT were assessed as prognostic factors.


RESULTS
The median survival was 6 months (range, 1-100), and 1- and 2-year survival rates were 28% and 17%, respectively. In univariate analysis, improved survival was associated with KPS of ≥70, absence of symptoms, radiation dose of ≥37.5 Gy, favorable primary lesion, LM, and surgery plus WBRT. Multivariate analysis revealed that these factors with the exception of radiation dose was significant prognostic factors for OS.


CONCLUSIONS
We found that LM were independent prognostic factors for good clinical outcomes.
Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
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M
Sakaguchi
Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
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T
Maebayashi
Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
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T
Aizawa
Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
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N
Ishibashi
Sonodakai Radiation Oncology Clinic, Adachi-ku, Tokyo, Japan.
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T
Saito
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
brain metastases; cerebrospinal fluid; leptomeningeal metastases; magnetic resonance imaging; radiotherapy