PURPOSE Leptomeningeal disease (LMD) is an aggressive complication of metastatic breast cancer (MBC) with brain metastases (BM), with a short survival of weeks to months. Studies suggest that surgical resection of BM may increases the risk of LMD, especially in infratentorial metastases. In this retrospective study, we examine this and other factors which may be associated with increased risk of LMD.
METHODS A database search at a single institution identified 178 patients with MBC and treated BM between 2007-2020. We collected demographic, clinical, radiographic and other treatment data. LMD was diagnosed by cerebrospinal fluid (CSF) cytology, neuroimaging, or both. Cox proportional hazards model was used.
RESULTS After a median follow up of 8.5 months, 41 out of 178 patients (23%) with BM developed LMD. Median time to develop LMD was 130 days. Mean age was 51.3 years. The number and size of the BM, hemorrhagic/cystic lesions, progressive/stable systemic disease, and extracranial metastases sites other than liver did not pose a higher risk of LMD. Infratentorial lesions (HR=5.41) and liver metastases (HR=2.28) had a higher risk of LMD. Patients who had any surgery did not have a higher risk for LMD (HR 1.13). The LMD group had a worse overall survival as compared to the non-LMD group.
CONCLUSIONS Among MBC patients with BM, infratentorial BM and visceral liver lesions increase the risk of LMD whereas local treatment modalities such as surgery and radiation do not. This data implies that local treatment strategy should not differ based on potential risk for LMD.