• Chi-Lu Chiang, Huai-Che Yang, Yung-Hung Luo, Ching-Jen Chen, Hsiu-Mei Wu, Yuh-Min Chen, Yong-Sin Hu, Chung-Jung Lin, Wen-Yuh Chung, Cheng-Ying Shiau, Wan-Yuo Guo, Teh-Ying Chou, David Hung-Chi Pan, and Cheng-Chia Lee.
• 1Departments of Chest Medicine.
• J. Neurosurg. 2023 Aug 1; 139 (2): 385392385-392.

ObjectiveStereotactic radiosurgery (SRS) is an effective treatment for brain metastases (BMs) in patients with non-small cell lung cancer (NSCLC). However, factors associated with the development of post-SRS leptomeningeal metastasis (LM) remain unclear. The authors analyzed the incidence and risk factors of LM development in patients with NSCLC and BMs after SRS and examined the survival outcomes and prognostic factors after LM development.MethodsThis retrospective study included patients with NSCLC treated with SRS for MRI-diagnosed BM from 2002 to 2021. The authors recorded various clinical and demographic data, including age, sex, tumor histology, molecular profile of tumors, extracranial disease status, previous craniotomy, Karnofsky Performance Status, systemic treatments, tumor volume, and number of BMs. The management and survival outcomes after LM diagnosis were also recorded.ResultsLM developed in 13.7% of patients with NSCLC and BMs after SRS treatment. Large initial tumor volume and more than 5 BM lesions, but not EGFR mutation status and post-SRS treatment, were associated with LM development after SRS. Multivariate analysis revealed that chemotherapy and targeted therapy after LM were associated with better survival in patients with LM after SRS.ConclusionsThis study is the first to evaluate the risk factors for LM in a relatively large cohort of patients with NSCLC after SRS. In patients with BMs harboring risk factors for subsequent LM, such as initial tumor volume and number of metastatic lesions, aggressive therapies with high CNS penetrating ability should be considered.

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