Early detection of leptomeningeal metastases among patients undergoing spinal stereotactic radiosurgery Journal Article
| Authors: | Freret, M. E.; Wijetunga, N. A.; Shamseddine, A. A.; Higginson, D. S.; Schmitt, A. M.; Yamada, Y.; Lis, E.; Boire, A.; Yang, J. T.; Xu, A. J. |
| Article Title: | Early detection of leptomeningeal metastases among patients undergoing spinal stereotactic radiosurgery |
| Abstract: | Purpose: The management of patients with advanced solid malignancies increasingly uses stereotactic body radiation therapy (SBRT). Advanced cancer patients are at risk for developing leptomeningeal metastasis (LM), a fatal complication of metastatic cancer. Cerebrospinal fluid (CSF) is routinely collected during computed tomography (CT) myelography for spinal SBRT planning, offering an opportunity for early LM detection by CSF cytology in the absence of radiographic LM or LM symptoms (subclinical LM). This study tested the hypothesis that early detection of tumor cells in CSF in patients undergoing spine SBRT portends a similarly poor prognosis compared with clinically overt LM. Methods and Materials: We retrospectively analyzed clinical records for 495 patients with metastatic solid tumors who underwent CT myelography for spinal SBRT planning at a single institution from 2014 to 2019. Results: Among patients planned for SBRT, 51 (10.3%) developed LM. Eight patients (1.6%) had subclinical LM. Median survival with LM was similar between patients with subclinical versus clinically evident LM (3.6 vs 3.0 months, P = .30). Patients harboring both parenchymal brain metastases and LM (29/51) demonstrated shorter survival than those with LM alone (2.4 vs 7.1 months, P = .02). Conclusions: LM remains a fatal complication of metastatic cancer. Subclinical LM detected by CSF cytology in spine SBRT patients has a similarly poor prognosis compared with standardly detected LM and warrants consideration of central nervous system-directed therapies. As aggressive local therapies are increasingly used for metastatic patients, more sensitive CSF evaluation may further identify patients with subclinical LM and should be evaluated prospectively. © 2022 The Authors |
| Keywords: | cancer survival; controlled study; human tissue; aged; major clinical study; cancer patient; cancer radiotherapy; nuclear magnetic resonance imaging; follow up; computer assisted tomography; retrospective study; histology; early diagnosis; brain metastasis; iohexol; stereotactic radiosurgery; stereotactic body radiation therapy; meningeal metastasis; cerebrospinal fluid cytology; myelography; cancer prognosis; human; male; female; article; early cancer diagnosis; solid malignant neoplasm |
| Journal Title: | Advances in Radiation Oncology |
| Volume: | 8 |
| Issue: | 2 |
| ISSN: | 2452-1094 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-03-01 |
| Start Page: | 101154 |
| Language: | English |
| DOI: | 10.1016/j.adro.2022.101154 |
| PROVIDER: | scopus |
| PUBMED: | 36845624 |
| PMCID: | PMC9943781 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK authors: Jonathan T. Yang and Amy J. Xu -- Source: Scopus |
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