COMPARATIVE RISK OF LEPTOMENINGEAL DISSEMINATION OF CANCER AFTER SURGERY OR STEREOTACTIC RADIOSURGERY FOR A SINGLE SUPRATENTORIAL SOLID TUMOR METASTASIS
- 1 April 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 64 (4), 664-676
- https://doi.org/10.1227/01.neu.0000341535.53720.3e
Abstract
To test the hypothesis that differential risks of developing leptomeningeal disease (LMD) exist in patients having a single supratentorial brain metastasis resected via a piecemeal or en bloc approach or treated with stereotactic radiosurgery (SRS).Between 1993 and 2006, 827 patients with a supratentorial brain metastasis underwent resection or SRS at The University of Texas M.D. Anderson Cancer Center. The primary outcome was the incidence of LMD.Resection was performed piecemeal in 191 patients and en bloc in 351 patients; 285 patients received SRS. LMD occurred in 33 patients, 29 in the resection group and 4 in the SRS group. Risk of LMD was significantly higher with piecemeal tumor resection than with other procedures (SRS: hazard ratio [HR] for piecemeal, 5.8; 95% confidence interval [CI], 1.9-17.2; P = 0.002; en bloc, HR for piecemeal, 2.7; 95% CI, 1.3-5.6; P = 0.009). The difference between piecemeal and en bloc was particularly pronounced in patients with a melanoma primary (HR, 8.4; 95% CI, 1.8-39.2; P = 0.007). The risk of LMD was not significantly different between en bloc resection and SRS (HR for en bloc, 2.1; 95% CI, 0.7-6.4; P = 0.21). Similar results were obtained when comparing effects of SRS and both resection approaches after limiting the sample to patients with tumors in a specific volume range.Piecemeal resection of a supratentorial brain metastasis carries a higher risk of LMD than en bloc resection or SRS. Further assessment of the role of the 2 surgical resection approaches and SRS in a controlled prospective setting with large numbers of patients is warranted.Keywords
This publication has 20 references indexed in Scilit:
- Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastasesInternational Journal of Radiation Oncology*Biology*Physics, 2000
- Leptomeningeal carcinomatosisCancer Treatment Reviews, 1999
- Current diagnosis and treatment of leptomeningeal metastasisJournal of Neuro-Oncology, 1998
- Carcinomatous meningitis in solid tumoursAnnals of Oncology, 1996
- Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasisAnnals of Neurology, 1995
- Inadvertent spread of cancer at surgeryJournal of Surgical Oncology, 1993
- Follow-up Study on Metastatic Cerebellar Tumor SurgeryNeurologia medico-chirurgica, 1990
- The Role of Postoperative Radiotherapy after Resection of Single Brain MetastasesNeurosurgery, 1989
- Management of solitary metastasis to the brain: The role of elective brain irradiation following complete surgical resectionInternational Journal of Radiation Oncology*Biology*Physics, 1980
- Malignant melanoma and central nervous system metastases.Incidence, diagnosis, treatment and survivalCancer, 1978