Breast brain metastases are associated with increased risk of leptomeningeal disease after stereotactic radiosurgery: a systematic review and meta-analysis
Desmond A Brown 1, Victor M Lu 2, Benjamin T Himes 2, Terry C Burns 2, Alfredo Quiñones-Hinojosa 3, Kaisorn L Chaichana 3, Ian F Parney 2Affiliations expand
- PMID: 31950392
- DOI: 10.1007/s10585-020-10019-1
Abstract
Brain metastases are the most common malignant tumors of the brain. Leptomeningeal dissemination is a late-stage complication of intracranial metastasis and portends an extremely poor prognosis. An increased risk of leptomeningeal disease (LMD) from metastatic breast cancer compared to other cancer types after stereotactic radiosurgery (SRS) has been reported. Validation of this observation has significant public health ramifications. The aim of this study was to determine the consistency of this association in the available literature via formal meta-analysis and systematic review of the literature. Searches of seven electronic databases from inception to August 2019 were conducted following PRISMA guidelines and appropriate selection criteria. Prognostic hazard ratios (HRs) for LMD in breast cancer brain metastases derived from multivariate regression analysis were analyzed using meta-analysis of proportions. Our search strategy identified 8 studies meeting inclusion criteria which provided data on 2555 unique brain metastases patients treated with SRS. The risk of LMD in the setting of breast cancer brain metastasis was significantly greater compared to other histologic cancer types (pooled HR = 2.22; 95% CI 1.69-2.93; P < 0.001). Statistical assessment of small studies bias and heterogeneity were negative. Outcome certainty was low. Breast cancer brain metastases are associated with an increased risk of LMD compared to other cancer types after SRS. The certainty of this outcome will be improved with future prospective studies. Providers should factor this increased susceptibility for LMD in breast cancer brain metastasis to allow for appropriate risk stratification and the development of appropriate surveillance paradigms.
Keywords: Brain metastasis; Breast cancer; LMD; Leptomeningeal disease; SRS; Stereotactic radiosurgery.
Similar articles
- Leptomeningeal disease following stereotactic radiosurgery for brain metastases from breast cancer.Trifiletti DM, Romano KD, Xu Z, Reardon KA, Sheehan J.J Neurooncol. 2015 Sep;124(3):421-7. doi: 10.1007/s11060-015-1854-6. Epub 2015 Jun 21.PMID: 26093620
- Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery.Huang AJ, Huang KE, Page BR, Ayala-Peacock DN, Lucas JT Jr, Lesser GJ, Laxton AW, Tatter SB, Chan MD.J Neurooncol. 2014 Oct;120(1):163-9. doi: 10.1007/s11060-014-1539-6. Epub 2014 Jul 22.PMID: 25048529 Clinical Trial.
- Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases.Atalar B, Modlin LA, Choi CY, Adler JR, Gibbs IC, Chang SD, Harsh GR 4th, Li G, Nagpal S, Hanlon A, Soltys SG.Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):713-8. doi: 10.1016/j.ijrobp.2013.07.034. Epub 2013 Sep 18.PMID: 24054875
- Stereotactic radiosurgery versus whole-brain radiotherapy after intracranial metastasis resection: a systematic review and meta-analysis.Lamba N, Muskens IS, DiRisio AC, Meijer L, Briceno V, Edrees H, Aslam B, Minhas S, Verhoeff JJC, Kleynen CE, Smith TR, Mekary RA, Broekman ML.Radiat Oncol. 2017 Jun 24;12(1):106. doi: 10.1186/s13014-017-0840-x.PMID: 28646895 Free PMC article. Review.
- Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases.Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL.Cochrane Database Syst Rev. 2017 Sep 25;9(9):CD006121. doi: 10.1002/14651858.CD006121.pub4.PMID: 28945270 Free PMC article. Review.
