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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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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立体定向放射治疗乳腺癌脑转移后脑白质病变：1077例病灶的单中心分析

背景脑白质病是颅内放射治疗（RT）后最常见和延迟的放射不良反应（ARE）。白质脑病患者会出现一定程度的认知和神经功能障碍。本研究评估了乳腺癌脑转移患者单纯立体定向放射手术（SRS）或全脑放射治疗（WBRT）后发生脑白质病变的频率和临床结果。方法回顾性评估2007年至2022年间接受SRS的乳腺癌患者脑转移的数据。检查MRI序列以评估白质变化和肿瘤控制。结果在125例1077例脑转移患者中，58例（46.4%）患者在SRS前接受了WBRT。到第3年，23.4%的WBRT + SRS患者发生高级别白质脑病（2-3级），而仅SRS组为5.7% （p < 0.001）。在单变量分析中，高级别白质脑病的显著预测因子包括既往WBRT （HR: 18.4, p = 0.005）、累积积分剂量（HR: 4.17, p = 0.029）和病变总数（HR: 1.22, p < 0.001）。在多变量分析中，既往WBRT （HR: 11.1, p = 0.022）和总病变（HR: 1.14, p = 0.037）仍然是显著的预测因子。结论：我们的研究结果表明，WBRT联合SRS比单独SRS与更高的脑白质病发病率相关。这强调了仔细权衡不同电离辐射方法在乳腺癌脑转移治疗中的益处和风险的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.