Clinical Scorecard: Outcomes of Leptomeningeal Disease Following Brain Metastasis Resection: Findings from the Multicenter SUBAROMA Trial

At a Glance

Key Highlights

• Up to 30% of patients with systemic cancer develop brain metastases.

• LMD is associated with poor prognosis and reduced overall survival.

• High overall disease burden and anatomical location of BM are predictors of LMD.

• Postoperative radiation therapy type influences LMD risk.

• The study aims to identify risk factors for LMD development.

Guideline-Based Recommendations

Diagnosis

• LMD diagnosed by MRI and/or CSF sampling.

Management

• Surgery indicated for neurological symptoms caused by BM.

Monitoring & Follow-up

• Regular clinical assessment and MRI follow-up.

Risks

• Piecemeal resection and intraoperative access to ventricles increase LMD risk.

Patient & Prescribing Data

Patients aged ≥ 18 years undergoing surgery for brain metastases.

Systemic therapy continued or initiated based on extracranial tumor manifestation.

Clinical Best Practices

• Utilize state-of-the-art surgical techniques for BM resection.

• Assess extent of resection using postoperative MRI.

• Implement interdisciplinary tumor board discussions for surgical indications.

Related Resources & Content

1. Journal of Neuro-Oncology, 2022 -- Local control and leptomeningeal disease after resection and GammaTile brachytherapy for newly diagnosed brain metastases: results from a prospective registry

2. Journal of Neuro-Oncology, 2021 -- Clinical Features and Outcomes of Leptomeningeal Disease With and Without Accompanying Brain Metastases: Findings from an Exploratory Analysis of the Charité LMD Database

3. Journal of Neuro-Oncology, 2021 -- Creation and assessment of a nomogram to predict the risk of leptomeningeal metastasis in brain metastases from NSCLC: influence of tumor site, genetic mutations, and stereotactic radiosurgery

4. Journal of Neuro-Oncology — Intraoperative radiotherapy after resection of newly diagnosed brain metastases in adult patients - results of a prospective phase II trial (INTRAMET)

5. EANO–ESMO Clinical Practice Guideline for diagnosis, treatment, and follow-up of leptomeningeal metastasis

6. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)

7. Leptomeningeal metastases from solid tumors: A Society for Neuro-Oncology and American Society of Clinical Oncology consensus review on clinical management and future directions - PMC

8. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial - PMC

9. Prospective Randomized Trial of Post-operative Stereotactic Radiosurgery versus Observation for Completely Resected Brain Metastases - PMC

10. Treatment of Brain Metastases Guideline - American Society for Radiation Oncology (ASTRO), ASCO, SNO

11. ASTRO issues clinical guideline on radiation therapy for brain metastases - American Society for Radiation Oncology (ASTRO)

12. Leptomeningeal disease and neurologic death after surgical resection and radiosurgery for brain metastases: A multi-institutional analysis - PubMed

13. Leptomeningeal disease in neurosurgical brain metastases patients: A systematic review and meta-analysis - PMC

14. role of neurosurgery for brain metastases between 2012 and 2022: Results of the multicenter SUBAROMA study | Neuro-Oncology Practice | Oxford Academic

15. Preoperative Stereotactic Radiosurgery for Brain Metastases: A Phase 1 Dose Escalation Study Demonstrating Reduced Leptomeningeal Disease - ScienceDirect

16. Osimertinib in Patients With Epidermal Growth Factor Receptor Mutation–Positive Non–Small-Cell Lung Cancer and Leptomeningeal Metastases: The BLOOM Study - PMC

17. Phase II Efficacy and Safety of 80 mg Osimertinib in Patients With Leptomeningeal Metastases Associated With Epidermal Growth Factor Receptor Mutation–Positive Non–Small Cell Lung Cancer (BLOSSOM) | Journal of Clinical Oncology

18. Osimertinib is associated with improved outcomes in pre-treated non-small cell lung cancer leptomeningeal metastases: A systematic review and meta-analysis - ScienceDirect

19. Tucatinib–trastuzumab–capecitabine for treatment of leptomeningeal metastasis in women with HER2+ breast cancer: TBCRC049 phase 2 study results - PMC