BM-21RISK OF NEOPLASTIC MENINGITIS FROM BRAIN METASTASES IN NSCLC INITIALLY TREATED WITHOUT WHOLE BRAIN IRRADIATION: A RETROSPECTIVE ANALYSIS OF A CASE SERIES

Characterize the risk of neoplastic meningitis (NM) in patients with brain metastasis from NSCLC. Determine site of relapse and cause of death. We analyzed 56 patients treated initially with surgery and / or radio surgery, with or without chemotherapy without WBI from July 2007 to May 2014, with a minimum follow-up of 4 months. The median age was 58 years (35-81), 30 male. The median follow up from diagnosis of brain metastases was 13 months (1-82). Twenty one patients had solitary metastasis. Median cerebral progression-free survival (PFSc) and survival from diagnosis of brain metastases (SVbm) were calculated by Kaplan-Meier. Initial treatment: 17 surgery, 11 surgery followed by radio surgery, 17 radio surgery and 11 surgery with adjuvant local radiation therapy. Thirty six (64%) had progression of CNS disease. Nine patients developed NM (16%), 5 of them contiguous to the surgical bed (neither of them have received focal radiotherapy) one patient after radiosurgery. Eleven patients underwent WBI at progression, 9 of them by NM, one patient with NM was lost in the follow up. The prognosis of the patients with NM was very poor with a median survival time of 4 months. Only three patients are alive with stable disease. One of the 11 patients that were treated with adjuvant focal radiotherapy relapsed locally or had NM. The median PFSc and SVbm were 9 and 13 months respectively. In 11 patients the cause of death was neurological progression, 5 of them by NM. Fifteen of 56 patients are alive. We must use adjuvant local radiotherapy on the surgical bed to decrease the risk of local relapse and NM if we chose to treat brain metastases without WBI.