Leukoencephalopathy following stereotactic radiosurgery for breast cancer brain metastases: a single-center analysis of 1,077 lesions

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY Acta Neurochirurgica Pub Date : 2025-03-14 DOI:10.1007/s00701-025-06478-8

Salem M. Tos, Bardia Hajikarimloo, Georgios Mantziaris, Mariam Ishaque, Purushotham Ramanathan, David Schlesinger, Jason P. Sheehan

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引用次数: 0

Abstract

Background

Leukoencephalopathy is the most prevalent and delayed adverse radiation effect (ARE) after intracranial radiotherapy (RT). Patients with leukoencephalopathy experience some levels of cognitive and neurological dysfunction. This investigation assessed the frequency and clinical outcomes of leukoencephalopathy following stereotactic radiosurgery (SRS) alone or SRS following whole-brain radiation therapy (WBRT) in breast cancer brain metastasis.

Methods

We retrospectively evaluated the data of brain metastases from breast cancer individuals who underwent SRS between 2007 and 2022. MRI sequences were examined to assess white matter changes and tumor control.

Results

Among 125 patients with 1,077 brain metastases, 58 (46.4%) patients received WBRT prior to SRS. By year 3, 23.4% of WBRT + SRS patients developed high-grade leukoencephalopathy (grades 2–3) compared to 5.7% in the SRS-only group (p < 0.001). In univariate analyses, significant predictors of high-grade leukoencephalopathy included prior WBRT (HR: 18.4, p = 0.005), cumulative integral dose > 3 J (HR: 4.17, p = 0.029), and the total number of lesions (HR: 1.22, p < 0.001). In multivariate analyses, prior WBRT (HR: 11.1, p = 0.022) and total lesions (HR: 1.14, p = 0.037) remained significant predictors.

Conclusion

Our findings demonstrated that WBRT plus SRS is associated with higher leukoencephalopathy rates than SRS alone. This underscores the importance of carefully weighing the benefits and risks of different ionizing radiation approaches in the management of brain metastasis from breast cancer.

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.