The Risk of Leukoencephalopathy After Whole Brain Radiation Therapy Plus Radiosurgery Versus Radiosurgery Alone for Metastatic Lung Cancer

Edward A. Monaco III, PhD, MD1, Amir Faraji1, Phillip Parry, MD1, Uri Hadelsberg1, Hideyuki Kano, MD, PhD1, Ajay Niranjan, MD1, Douglas S. Kondziolka, MD1, L. Dade Lunsford, MD1

1Pittsburgh, PA United States

Keywords: radiotherapy, brain metastasis, gamma knife, lung cancer, radiosurgery

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     As systemic therapies improve and patients live longer, concerns mount about the toxicity of whole brain radiation therapy (WBRT) for management of brain metastases. The development of delayed white matter abnormalities indicative of leukoencephalopathy have been correlated with cognitive dysfunction.
     The present study assesses the risk of imaging-defined leukoencephalopathy in patients whose management included WBRT in addition to stereotactic radiosurgery (SRS). We compare this to the risk in patients who only underwent SRS.
     We retrospectively matched 37 patients with non-small cell lung cancer (NSCLC) who underwent WBRT plus SRS to 31 who underwent only SRS. All patients survived at least one year.
     We graded the development of delayed white matter changes on magnetic resonance imaging (MRI) using a scale to evaluate T2/FLAIR images after treatment: grade 1 = little or no white matter hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity.
     Patients treated with WBRT and SRS had a significantly greater incidence of delayed white matter leukoencephalopathy when compared to patients who underwent SRS alone (p < 0.001). At imaging follow up, 36 of 37 patients (97.3 %) treated by WBRT developed leukoencephalopathy (25% grade 2; 70.8% grade 3). Only one of 31 patients treated with SRS alone developed leukocenephalopathy.
     This is a retrospective study.
     Risk of leukoencephalopathy after SRS only was significantly lower than for patients who had WBRT.
     Our study provides further support for the use of SRS as primary management for NSCLC brain metastases. This approach virtually eliminates the risk of leukocencephalopathy in long-term survivors.


Project Roles:

E. Monaco III (), A. Faraji (), P. Parry (), U. Hadelsberg (), H. Kano (), A. Niranjan (), D. Kondziolka (), L. Lunsford ()