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@ARTICLE{Wasilewski:298896,
      author       = {D. Wasilewski$^*$ and C. Eitner and R. Ates and S. Murad
                      and Z. Shaked and J. A. Steinle and A. Wetzel-Yalelis and T.
                      A. Sargut and J. Rösler and M. A. Samman and P.
                      Truckenmüller and R. Mertens and D. Kroneberg and A. Kowski
                      and H. Radbruch and D. Capper$^*$ and F. Ehret$^*$ and S.
                      Roohani$^*$ and N. Frost and J. Nawabi and J. Onken$^*$ and
                      M. Schlaak and J.-U. Blohmer and U. Pelzer and U. Keller$^*$
                      and J. Sehouli and P. Vajkoczy and U. Keilholz$^*$ and M.
                      Misch},
      title        = {{C}linical characteristics and outcomes in leptomeningeal
                      disease with or without brain metastasis: insights from an
                      explorative data analysis of the {C}harité {LMD} registry.},
      journal      = {Journal of neuro-oncology},
      volume       = {nn},
      issn         = {0167-594X},
      address      = {Dordrecht [u.a.]},
      publisher    = {Springer Science + Business Media B.V},
      reportid     = {DKFZ-2025-00339},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {Leptomeningeal disease (LMD) involves disseminating cancer
                      cells to the leptomeninges and cerebrospinal fluid. The
                      impact of intracranial parenchymal brain metastases and
                      extracranial disease burden at LMD diagnosis remains
                      unclear. This study evaluates these factors alongside local
                      and systemic therapies before and after LMD diagnosis.A
                      retrospective analysis was conducted on 188 patients
                      diagnosed with LMD between 2011 and 2024. Data on
                      demographics, imaging findings, and treatments were
                      collected. Kaplan-Meier estimates were used for survival
                      analysis, and independent prognostic factors were identified
                      using a backward-stepwise Cox regression model.Primary
                      cancers included breast cancer $(34.0\%),$ non-small cell
                      lung cancer $(22.3\%),$ and melanoma $(14.4\%).$ LMD was
                      diagnosed via MRI in $56.4\%$ of cases, cerebrospinal fluid
                      (CSF) cytology in $2.7\%,$ and both in $41.0\%.$ Median
                      overall survival was 2.8 months $[95\%$ CI: 2.4 - 3.7].
                      Independent prognostic factors for improved survival
                      included male sex (HR: 0.61 $[95\%$ CI: 0.40 - 0.93], p =
                      0.020), absence of hydrocephalus at LMD diagnosis (HR: 0.42
                      $[95\%$ CI: 0.22 - 0.79], p = 0.007), and targeted therapy
                      post-diagnosis (HR: 0.33 $[95\%$ CI: 0.20 - 0.55], p <
                      0.001). Two or more lines of systemic therapy before LMD
                      diagnosis increased mortality risk (HR: 1.73 $[95\%$ CI:
                      1.16 - 2.59], p = 0.007). Lack of CNS parenchymal disease at
                      LMD diagnosis also increased risk (HR: 0.51 $[95\%$ CI: 0.30
                      - 0.89], p = 0.017). Pre-diagnosis radiation therapy showed
                      no survival benefit, while post-diagnosis radiation improved
                      outcomes (HR: 0.47 $[95\%$ CI: 0.32 - 0.70], p <
                      0.001).Absence of hydrocephalus and use of targeted therapy
                      post-diagnosis are favorable prognostic factors, while
                      extensive prior systemic therapy and CNS parenchymal disease
                      worsen outcomes. Tailored therapies addressing intracranial
                      disease are crucial for improving survival in LMD patients.},
      keywords     = {Brain metastasis (Other) / Breast cancer (Other) / Lung
                      cancer (Other) / Melanoma (Other) / Radiotherapy (Other) /
                      Re-resection (Other) / Resection (Other) / Survival (Other)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39932528},
      doi          = {10.1007/s11060-025-04937-x},
      url          = {https://inrepo02.dkfz.de/record/298896},
}