2115 - Impact of Stereotactic Radiosurgery (SRS) on Cancer Patients with Leptomeningeal Disease (LMD)
Presenter(s)
S. Koduri1, C. M. Liu2, A. Jambhale2, C. Oh3, K. Bernstein1, M. Mureb4, J. S. Silverman1, B. T. Cooper5, B. R. Donahue1, A. Gewirtz6, A. Miller7, J. R. McFaline-Figueroa8, D. Kondziolka9, and J. T. Yang5; 1Department of Radiation Oncology, NYU Langone Health, New York, NY, 2NYU Grossman School of Medicine, New York, NY, 3Biostatistics, Department of Population Health, NYU Langone Health, New York, NY, 4Department of Neurosurgery, Westchester Medical Center, Vahalla, NY, 5Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, 6Department of Neurology, NYU Grossman Long Island School of Medicine, New York, NY, 7Department of Neurology, NYU Grossman School of Medicine, New York, NY, 8NYU Langone Health, New York City, NY, 9Department of Neurosurgery, NYU Langone Health, New York, NY
Purpose/Objective(s):
Leptomeningeal disease (LMD) is a late-stage progression of metastatic cancer to the meningeal membranes and cerebrospinal fluid (CSF) surrounding brain and spinal cord. This is a retrospective study that explores clinical outcomes within the population who receive stereotactic radiosurgery (SRS) for LMD.Materials/Methods:
Patients who received Gamma Knife Radiosurgery for LMD at our institution were retrospectively reviewed. Extent of LMD was retrospectively recorded using the EANO-ESMO guidelines. Clinical factors and outcomes, including central nervous system (CNS) disease control and survival, were analyzed using univariate and multivariate Cox regression analyses. CNS progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier estimation.Results:
Between 2008 and 2025, 126 patients at our institution were treated with SRS for LMD from metastatic cancer. Most patients were female (59%), with a median age of 64 (54-72) and median Karnofsky Performance Status (KPS) of 90 (80-90). 52% of patients had a lung cancer primary, followed by 17% melanoma and 16% breast cancer. Out of 126 patients, 14 (11%) had lumbar puncture for CSF assessment, and 4 (3%) had positive cytology. 103 (82%) patients were diagnosed based on radiographic and clinical signs and 19 (15%) were diagnosed by MRI findings alone. 25 (20%) patients had linear enhancement on imaging, 81 (64%) had nodular enhancement on imaging and 20 (16%) had both. The median time from LMD diagnosis to SRS was 6 days (range 0-28 days), and 7 (5.6%) patients received prior whole brain radiotherapy (WBRT). The median PFS and OS after SRS were 6.3 (IQR 3.2–22.5) and 8.7 (IQR 1.7–16.9) months, respectively. In multivariate analyses, patients with longer intervals between LMD diagnosis and SRS (HR = 0.81, 95% CI 0.66-0.99, p = 0.04) had improved CNS PFS. Additional analyses showed higher KPS (HR= 0.96, 95% CI=0.93-0.98, p<0.001) and more courses of SRS (HR=0.96, 95% CI= 0.93-0.98, p<0.001) were also associated with improved CNS PFS. Patients with higher KPS had improved OS (HR = 0.96 per 1-point increase, 95% CI 0.93–0.98; p < 0.001). Patient’s primary diagnosis, systemic treatments, surgical treatments, status of extracranial disease status, or EANO-ESMO LMD type were not found to have significant impact on CNS PFS or OS in this cohort. Excluding the 7 patients who received WBRT prior to SRS, 25 of the remaining 119 patients (21%) required WBRT following SRS.Conclusion:
This study explored real-world outcomes among patients with primarily radiographic and clinical LMD treated with SRS. Longer intervals between LMD diagnosis and SRS appear to be associated with improved OS in patients who received SRS as the first line local therapy for LMD with 21% of patients requiring WBRT after SRS. This study highlights the need to understand the natural history of LMD to allow for better treatment selection.