Authors: Or CohenInbar Patrick Melmer Chengchia Lee Zhiyuan Xu David Schlesinger Jason P Sheehan
Publish Date: 2015/10/14
Volume: 126, Issue: 2, Pages: 289-298
Abstract
Brain metastases BM develop in 10–30 of patients Stereotactic radiosurgery SRS was shown to improve local control and performance status in certain cohorts of brain metastasis patients The cumulative neurocognitive effect of numerous SRS sessions remains unknown Leukoencephalopathy is significant diffuse white matter changes and it usually implies a neurocognitive decline We report patients with BM who survived 2 years after SRS Clinical and treatment parameters were analyzed for development of leukoencephalopathy Multiple parameters as well as leukoencephalopathy grade changes were recorded The median clinical and radiological followup was 42 and 41 months range 24–115 and 24–115 respectively The cohort included 92 patients and 704 lesions The most common malignancies were nonsmall cell lung carcinoma 445 n = 41 breast adenocarcinoma 239 n = 22 and melanoma 163 n = 15 276 n = 26 of patients underwent adjuvant WBRT At last follow up local tumor control was achieved in 763 n = 61 of patients and 718 n = 461 of lesions Overall prevalence of leukoencephalopathy was 42 60 73 and 84 at 1 2 3 and 4 years after SRS Moderatesevere leukoencephalopathy development was related to an integral dose to skull 3 Joules p = 0012 at any radiosurgical treatment and prior WBRT p 0042 Leukoencephalopathy incidence was consistently higher in the WBRT + SRS group at each following year of survival from initial SRS Longterm BM survivors treated with SRS are at progressive risk for developing leukoencephalopathy Those with a higher BM burden higher integral SRS dose to the skull and treatment with WBRT are at increased risk of leukoencephalopathy
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