Journal of Neuro-Oncology最新文献

{"title":"Linear regression models predict survival and complication rates in patients undergoing gamma knife radiosurgery for recurrent and residual craniopharyngiomas: a meta-analysis of 743 tumors.","authors":"Bhavya Pahwa, Sanah Mahajan, Nishtha Pahwa, Nicholas Panico, Jason P Sheehan","doi":"10.1007/s11060-025-05196-6","DOIUrl":"10.1007/s11060-025-05196-6","url":null,"abstract":"<p><strong>Purpose: </strong>Craniopharyngiomas are clinically aggressive benign tumors that present a special challenge for clinicians due to high recurrence rates and post operative compilations. Surgical intervention alone poses many challenges and therefore, the use of radiotherapeutic adjuvant modalities has become common. This study aims to evaluate the effectiveness of gamma knife radiosurgery (GKRS) in the management of recurrent and residual craniopharyngiomas and identify the factors that could predict survival and complication rates.</p><p><strong>Methods: </strong>PubMed and Cochrane library were screened from inception until September 2024. Fixed effect models (I² < 50%) and Random effects models (I² > 50%) were created to study the pooled survival rates and complication rates. Linear Regression models were generated to identify the prognostic factors and F-test was used to check the significance of the models.</p><p><strong>Results: </strong>The meta-analysis included 743 tumors from nine selected studies. Estimated 3, 5 and 10 year OS rates were 96%, 93% and 85% respectively and estimated 3, 5 and 10 year PFS rates were 83%, 68% and 45% respectively. Estimated visual (VD) and endocrinological dysfunction (ED) rates were 5% and 4% respectively. Median marginal dose ≤ 13 Gy was the independent predictor of 3 year OS (β = 1.95, p = 0.02), while female patients (β=-0.52, p = 0.023), age (β=-0.36, p = 0.04) and median marginal dose ≤ 13 Gy (β = 2.55, p = 0.001) were found to be significant predictors of 5 year OS. F-test revealed that the models generated for 3 year and 5 year OS rates were significant with an excellent R² values of 0.99 (p = 0.03) and 0.98 (p = 0.008) respectively. Age was the single significant predictor of VD (β=-0.80, p = 0.032) while tumor volume (β = 0.61, p = 0.035) and median marginal dose ≤ 13 Gy (β=-1.17, p = 0.039) were significant predictors of ED.</p><p><strong>Conclusions: </strong>GKRS is an effective treatment modality for recurrent and residual craniopharyngiomas, providing comparable to improved survival rates to other modalities and significantly lower complication rates with a safe dose of ≤ 13 Gy.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"933-942"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world experience outcome in patients with central nervous system metastases: information on 2,226 patients during a 15-year period.","authors":"Oscar Arrieta, Alexandra Díaz-Alba, Sergio Moreno-Jiménez, Alejandro Rodríguez-Camacho, Enrique Caballe-Pérez, Marco Antonio Rodríguez-Florido, Alberto González-Aguilar, Ytel Garcilazo-Reyes, Mónica Alicia Sierra-Del-Río, Fernando Alcides Lozano-Sánchez, Bernardo Cacho-Díaz","doi":"10.1007/s11060-025-05190-y","DOIUrl":"10.1007/s11060-025-05190-y","url":null,"abstract":"<p><strong>Purpose: </strong>Most data regarding Central nervous system (CNS) metastases are derived from non-Hispanic populations enrolled in clinical trials. This study aims to characterize the primary tumors, initial treatments, and outcomes in a Hispanic/Latino real-world population with CNS metastases.</p><p><strong>Methods: </strong>A retrospective analysis of a multicenter cohort of patients with CNS metastases treated from 2010 to 2024.</p><p><strong>Results: </strong>From 2,261 patients with CNS metastases, 84% had brain metastases and 16% had neoplastic meningitis. The most common primary tumors were breast (40%), lung (27%), genitourinary (11%), gynecologic (6%), and melanoma (4%). Whole-brain radiotherapy and systemic therapy were initially prescribed in 84% and 55% of cases, respectively. The median overall survival was 9.8 months (95% CI, 8.9 - 10.7). Variables associated with outcomes included location of the primary tumor, molecular subtype, type of CNS metastases (brain metastases vs. neoplastic meningitis), and access to targeted therapies.</p><p><strong>Conclusion: </strong>In a real-world cohort of Hispanic/Latino patients with CNS metastases, survival has remained poor over the past 15 years. This highlights the need for interventions and research to improve outcomes.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1227-1234"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photodynamic therapy for glioblastoma: a narrative review.","authors":"Gabrielle Price, Stephen C Frederico, Jhair Colan, Frederika Rentzeperis, Sakibul Huq, Constantinos Hadjipanayis","doi":"10.1007/s11060-025-05217-4","DOIUrl":"10.1007/s11060-025-05217-4","url":null,"abstract":"<p><strong>Purpose: </strong>Glioblastoma (GBM) remains one of the most aggressive primary brain tumors with poor survival outcomes and a lack of approved therapies. A promising novel approach for GBM is the application of photodynamic therapy (PDT), a localized, light-activated treatment using tumor-selective photosensitizers. This narrative review describes the mechanisms, delivery systems, photosensitizers, and available evidence regarding the potential of PDT as a novel therapeutic approach for GBM.</p><p><strong>Methods: </strong>A comprehensive review of the preclinical and clinical literature was conducted on the role of PDT for GBM. Special emphasis was placed on PDT's mechanisms of action, immunomodulatory effects, delivery systems, and combinatorial potential with other treatment regimens. All clinical trials on this topic were reviewed and described.</p><p><strong>Results: </strong>PDT exerts tumor-specific cytotoxic effects via reactive oxygen species generation, vascular disruption, and immune activation. Photosensitizers such as 5-aminolevulinic acid (5-ALA), chlorins, and phthalocyanines demonstrate selective accumulation in glioma cells and enhance treatment precision. Preclinical studies demonstrate that PDT can induce apoptosis, improve blood-brain barrier permeability, and synergize with existing chemotherapeutics. Early-phase clinical trials, including the INDYGO and talaporfin sodium-based studies, report promising safety profiles and extended survival in newly diagnosed and recurrent GBM patients.</p><p><strong>Conclusion: </strong>PDT offers a novel targeted approach for improving local control of GBM. With continued innovation in photosensitizer design, delivery technologies, and combinatorial strategies, PDT holds promise as a viable therapeutic adjunct in GBM treatment. Further clinical validation through randomized controlled trials is warranted to establish its efficacy and gain regulatory approval with the eventual goal of integration into standard neuro-oncology practice.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"921-931"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"A comparison of outcomes after radiosurgery in non-small cell lung cancer patients with one versus more than twenty brain metastases: an international multi-center study\".","authors":"Eduardo Urias, Cristina DeCesaris","doi":"10.1007/s11060-025-05187-7","DOIUrl":"10.1007/s11060-025-05187-7","url":null,"abstract":"","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1469-1470"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma knife radiosurgery for breast cancer brain metastasis: survival outcomes, prognotic factors, and the role of repeat treatment.","authors":"Ching-Ying Wang, Chun-Fu Lin, Huai-Che Yang, Chun-Yu Liu, Jiun-I Lai, Hsiu-Mei Wu, Wen-Yuh Chung, Cheng-Ying Shiau, Wan-Yuo Guo, Cheng-Chia Lee","doi":"10.1007/s11060-025-05188-6","DOIUrl":"10.1007/s11060-025-05188-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated prognostic factors and longitudinal outcomes associated with gamma knife radiosurgery (GKRS) in treating brain metastases from breast cancer, and assessed the efficacy of repeated GKRS in prolonging intracranial disease control.</p><p><strong>Methods: </strong>In this retrospective study, we reviewed 159 breast cancer patients involving 640 brain metastases who underwent GKRS at a tertiary medical center. Overall survival (OS), local control (LC), and distant intracranial control were estimated using the Kaplan-Meier method. Prognostic factors were estimated using Cox regression models. The effect of repeat GKRS on intracranial disease control was also examined.</p><p><strong>Results: </strong>The median OS was 19.2 months. In multivariate analysis, the Karnofsky Performance Scale (KPS), HER2 positivity, and ER/PR positivity were independently associated with longer survival. LC rates were 88.9% at 6 months and 83.0% at 12 months. Factors significantly associated with improved LC included a higher margin dose, HER2-negative status, smaller tumor volume, and absence of prior whole-brain radiotherapy (WBRT). Distant intracranial failure within 12 month occurred in 57.0% of patients. Median intracranial control among the 44 patients who underwent repeated GKRS (28.1 months) was significantly longer than those who received single GKRS (8.0 months; p < 0.001).</p><p><strong>Conclusion: </strong>GKRS provides effective local tumor control and favorable survival outcomes for patients with breast cancer brain metastases. KPS score and receptor status (ER/PR and HER2) are significant predictors of overall survival. Repeat GKRS is a promising strategy for prolonging intracranial control and may reduce the need for WBRT or surgical intervention in selected patients.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1401-1413"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain metastases from ovarian cancer: neuroradiological profile and survival overview of neurosurgical cases.","authors":"Carolina Giordano, Carolina Maria Sassu, Claudia Marchetti, Giulia Guerri, Andrea De Filippis, Serena Gulotta, Giammaria Marziali, Giorgia Russo, Amato Infante, Pier Paolo Mattogno, Alessandro Olivi, Anna Fagotti, Giovanni Scambia, Evis Sala, Benedetta Gui, Simona Gaudino","doi":"10.1007/s11060-025-05192-w","DOIUrl":"10.1007/s11060-025-05192-w","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to identify the radiological features of brain metastases (BM) from ovarian cancer (OC) and correlate them to clinical and genetic data. Additionally, the impact of neurosurgery on patient survival is evaluated.</p><p><strong>Materials and methods: </strong>A single-center, retrospective, observational study was conducted, involving 106 patients with BM from OC. Neuroradiological imaging was available for 66 patients. The data collected were analyzed using linear correlation and ANOVA tests and multivariable Cox proportional hazards regression for survival analysis. Survival was assessed using Kaplan-Meier curves.</p><p><strong>Results: </strong>The most prevalent histological subtypes were high grade serous (90%) OC. The main neuroradiological feature was necrosis (79%). BM were multiple in 56% of cases, with a prevalent distribution in the cerebral hemispheres (80.30%). Additional neuroradiological features included a volume greater than 1000 mm³ (71%), hemosiderin deposits on SWI (67%), abundant perilesional edema (53%), and the presence of hemorrhage (15%). The mean apparent diffusion coefficient (ADC) value of BM was 781.5 × 10^-6 mm²/s, while relative cerebral volume (rCBV) was lower in patients with posterior fossa BM (p = 0.049). Neurological symptoms were present in 39% of cases, and a linear correlation was identified between neurological symptoms and both tumor volume (p = 0.0008) and the presence of necrosis (p = 0.04). The BRCAm was associated to longer survival (p = 0.04) and was associated with less perilesional edema (OR = 0.145, CI: 0.027-0.776). The Kaplan-Meier analysis showed an overall survival (OS) of 46 months in BRCAwt patients who underwent neurosurgery, vs. 37 months in patients who did not (p = 0.03). Cox analysis identified BRCAm status, performance status, post-BM chemotherapy, and CNS-only disease as independent predictors of better survival; surgery was not significant.</p><p><strong>Conclusion: </strong>The current study supports the established protective value of the BRCA mutation and suggests that neurosurgical treatment of BM after a comprehensive evaluation may improve survival, even in BRCAwt patients.</p><p><strong>Clinical relevance statement: </strong>The critical need for early detection of BMs that are appropriate for surgical intervention is highlighted, as timely action can greatly improve patient outcomes.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1285-1298"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvessel density as a prognostic and predictive biomarker in newly diagnosed glioblastoma: correlations with radiological features and bevacizumab efficacy.","authors":"Atsushi Kambe, Ryoya Ochiai, Karen Makishima, Sachiko Yasuda, Irfan Kesumayadi, Tomohiro Hosoya, Makoto Sakamoto, Shinya Fujii, Masamichi Kurosaki","doi":"10.1007/s11060-025-05210-x","DOIUrl":"10.1007/s11060-025-05210-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the prognostic significance of microvessel density (MVD), assessed by CD34 immunohistochemistry (IHC), and its correlation with radiological features and bevacizumab (BEV) treatment efficacy in newly diagnosed glioblastoma.</p><p><strong>Methods: </strong>We retrospectively analyzed 41 patients with newly diagnosed glioblastoma. MVD was quantified using CD34 IHC, and patients were stratified into low and high MVD groups according to the cutoff value determined by receiver operating characteristic curve analysis (sensitivity, 76.5%; specificity, 75.0%; AUC, 0.725). Radiological characteristics-including relative cerebral blood flow (rCBF), peritumoral edema, and cystic components-were assessed. Survival outcomes were compared using Kaplan-Meier analysis. Treatment responses to temozolomide (TMZ) with or without BEV were evaluated in both MVD groups.</p><p><strong>Results: </strong>Patients in the low MVD group exhibited significantly longer progression-free survival (PFS, p < 0.001) and overall survival (OS, p < 0.001) than those in the high MVD group. Low MVD was associated with significantly lower rCBF, less peritumoral edema, and a higher prevalence of cystic components. All six cystic-type cases were found in the low MVD group and showed favorable prognosis. The addition of BEV to TMZ significantly prolonged PFS in the high MVD group (p = 0.001) but not in the low MVD group, with no OS benefit observed in either group.</p><p><strong>Conclusion: </strong>MVD serves as a prognostic biomarker and may help predict BEV treatment efficacy in glioblastoma. Combined with radiological features, MVD assessment could support more individualized therapeutic strategies. Further prospective studies using both CD34 protein and mRNA expression are warranted to validate these findings.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1311-1319"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, natural history and surgical outcome of spinal meningiomas in NF2-related schwannomatosis.","authors":"Louise Deboeuf, Antoine Keraudy, Thiebaud Picart, Giorgio Haddad, Imen Bernaoui, Samiya Abi Jaoude, Nozar Aghakhani, François Ducray, Timothée Jacquesson, David Meyronet, Cédric Y Barrey, Emmanuel Jouanneau, Michel Kalamarides, Rabih Aboukais, Matthieu Peyre","doi":"10.1007/s11060-025-05231-6","DOIUrl":"10.1007/s11060-025-05231-6","url":null,"abstract":"<p><strong>Purpose: </strong>Meningiomas are the second most common type of tumor associated with Neurofibromatosis Type 2 Schwannomatosis (NF2-SWN). While the characteristics of intracranial meningiomas have been extensively studied, data on the epidemiological and histological features of spinal meningiomas (SM) remain limited.</p><p><strong>Methods: </strong>An observational, retrospective study was conducted on NF2-SWN patients who underwent surgical resection of SMs at three NF2-SWN reference centers. Data were compared to a cohort of patients operated on for sporadic SM at Pitié-Salpêtrière Hospital. To evaluate the prevalence of spinal meningiomas in NF2-SWN, we analyzed the craniospinal MRIs of NF2-SWN patients followed at the Pitié-Salpêtrière Hospital.</p><p><strong>Results: </strong>Nineteen NF2-SWN patients who underwent surgery for 29 SMs between 1996 and 2024 were included (median age at surgery: 22 years; IQR:10-43). The most common location was the thoracic spine (22 cases, 76%). NF2-SWN patients were significantly younger than those with sporadic SMs (32 vs. 64 years; p < 0.001), and the female predominance was less pronounced (2:1 vs. 9:1; p = 0.01). Patients with sporadic tumors had a significantly shorter time to surgery (6.3 vs. 36.5 months; p < 0.001). No significant differences were observed between the two groups regarding tumor location, dural attachment, grade, histological subtype, rate of complete resection (85% vs. 89%; p = 0.5), or recurrence risk (8% vs. 9%; mean follow-up: 7.5 years; p = 0.9). Among the 115 NF2-SWN patients with at least one brain and spinal MRI, 39 (34%) had a SM. Patients with SM more frequently harbored intracranial meningiomas (95%) compared to NF2-SWN patients without SM (64%; p < 0.001).</p><p><strong>Conclusion: </strong>Spinal meningiomas are common in NF2-SWN, mostly found in association with intracranial meningiomas and correlate with a higher tumor burden and more severe disease phenotype. However, these tumors progress slowly, rarely require surgical intervention, and do not demonstrate higher histopathological aggressiveness compared to sporadic spinal meningiomas.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1001-1010"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of re-challenge with temozolomide in grade 2/3 IDH mutant gliomas at first progression.","authors":"Lalanthica V Yogendran, Abhinav Kareddy, Salma O Abbas, Zachary Scharf, James Patrie, Sohil H Patel, David Schiff","doi":"10.1007/s11060-025-05087-w","DOIUrl":"10.1007/s11060-025-05087-w","url":null,"abstract":"<p><strong>Background: </strong>Patients with WHO grade 2 and 3 isocitrate dehydrogenase mutation (IDHmt) gliomas commonly receive temozolomide (TMZ), with or without radiation therapy, as initial therapy. At progression, TMZ is sometimes reinstated despite a paucity of data on effectiveness.</p><p><strong>Methods: </strong>We reviewed imaging outcomes of patients with WHO 2016 grade II/III IDHmt gliomas re-treated with TMZ at first progression between 2007 and 2019. Tumor growth rates were calculated over the year preceding re-treatment and throughout the re-treatment period, ranging from 3 to 41 months. RANO criteria were utilized to assess TMZ response rate.</p><p><strong>Results: </strong>15 subjects included six grade II, five grade III oligodendrogliomas, one grade II and three grade III astrocytomas. Median time between completion of the first TMZ course and initiation of re-treatment was 47 months. Median progression-free survival with TMZ re-treatment was 27.4 months and median overall survival was 47.8 months. Mean rate of tumor growth by bidimensional product increased from 0.29 cm² /month, in the year prior to first tumor progression, to 0.47 cm²/month during re-treatment, ranging from 3 to 41 months, with monotherapy TMZ. Volumetric mean rate of tumor growth was 1.12 cc/month in the year prior to first tumor progression versus 1.29 cc/month during TMZ re-treatment. Five patients experienced tumor growth rate reduction, of whom 3 patients experienced tumor shrinkage as measured by 2D; 2 of these 3 patients also experienced tumor shrinkage as measured by 3D. There was no radiographic response by RANO criteria.</p><p><strong>Conclusion: </strong>These findings suggest previously treated, progressive IDHmt gliomas are generally resistant to TMZ, underscoring the need for alternative approaches.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1147-1154"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a predictive nomogram for leptomeningeal metastasis risk in NSCLC brain metastases: role of tumor location, driver mutations, and stereotactic radiosurgery.","authors":"Shoaib Bashir, Song Jian, Weiping Hong, Hui Wang, Mingyao Lai, Hanbo Lin, Qianwen Liang, Meng Xu, Linbo Cai","doi":"10.1007/s11060-025-05220-9","DOIUrl":"10.1007/s11060-025-05220-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-small cell lung cancer (NSCLC) frequently metastasizes to the leptomeninges, typically following brain parenchymal metastases (BM), with a significant impact on prognosis. However, predictors of leptomeningeal metastasis (LM) development remain poorly characterized. This study aimed to identify independent risk factors for subsequent LM development and establish a predictive nomogram for clinical risk stratification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The final analysis included 112 pathologically definite NSCLC patients with BM, treated at Sanjiu Brain Hospital between July 2014 and December 2020, who had not undergone whole brain radiation therapy before LM diagnosis. LM diagnosis was made if the patient had a history of pathologically confirmed lung cancer, new signs and symptoms of the nervous system, and positive CSF cytology or typical MRI findings. The data were retrospectively collected following the initial BM diagnosis until the patient was diagnosed with LM or died of any cause without developing LM. MR images were reviewed independently by two well-experienced radiologists in a double-blind manner. The primary outcome was to identify factors associated with the development of LM following BM diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the present study, two study cohorts were analyzed: (1) NSCLC-BM patients who subsequently developed LM (n = 56), and (2) NSCLC-BM patients who did not develop LM until death (n = 56). The median follow-up time for the entire cohort was 9.9 months (IQR, 4.2-18.2 months) following BM diagnosis. Univariate analysis identified several potential risk factors including EGFR/ALK/ROS1 mutations (OR = 3.868, 95% CI 1.583-10.079, P = 0.003), ventricle- or pia mater-adherent BMs (OR = 10.278, 95% CI 4.203-27.375, P &lt; 0.001), and stereotactic radiosurgery (SRS) as a protective factor (OR = 0.024, 95% CI 0.001-0.12, P &lt; 0.001). Multivariable logistic regression confirmed adherent BMs (OR = 9.846, 95% CI 2.981-40.176, P &lt; 0.001) and driver mutations (OR = 5.501, 95% CI 1.444-25.893, P = 0.018) were independent predictors of increased LM risk, while SRS significantly reduced LM risk (OR = 0.029, 95% CI 0.001-0.179, P = 0.002). Fine-Gray competing risks analysis (death without developing LM as competing event) yielded consistent results: adherent BMs (HR = 3.17, 95% CI 1.68-5.97, P &lt; 0.001), mutations (HR = 2.99, 95% CI 1.03-8.70, P = 0.045), and protective effect of SRS (HR = 0.25, 95% CI 0.14-0.46, P &lt; 0.001). A nomogram incorporating these three factors demonstrated excellent predictive performance with an area under the receiver operating characteristic curve of 0.885 and a C-index of 0.805.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients with adherent BMs and driver mutations appear to be associated with increased LM risk, while SRS may be associated with reducing this risk. Our novel nomogram incorporating these factors shows promising predictive performance in our cohort, potentia","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1377-1390"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}