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Pachymeningeal disease: a systematic review and metanalysis
Enrique Gutiérrez-Valencia1, Irving Sánchez2, Adrián Valles2
1MHA Radiation Medicine Program, Princess Margaret Cancer Center, University of Toronto, 7th Floor, OPG Building, 700 University Ave., Toronto, ON, M5G2M9, Canada. Enrique.Gutierrez@rmp.uhn.ca.
Background:
Pachymeningeal disease (PMD) is a newly recognized pattern of brain metastasis (BrM) failure that specifically occurs following surgery with adjuvant stereotactic radiosurgery (SRS) and has unique prognostic implications relative to leptomeningeal disease (LMD). Here, we report its prevalence, prognostic implications, and associated risk factors.
Methods:
A literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses on PUBMED and Cochrane from January 2000 to June 2023.
Results:
We identified 12 studies that included a total of 3992 BrM patients, 659 (16.5%) of whom developed meningeal disease (MD) following surgery plus adjuvant SRS, including either PMD or LMD. The mean prevalence of MD across studies was 20.9% (7.9-38.0%), with PMD accounting for 54.6% of this prevalence and LMD comprising the remaining 45.4%. Mean of the median overall survivals following diagnosis of PMD and LMD was 10.6 months and 3.7 months p = 0.007, respectively, a significant difference. Only 2 risk factors for PMD were reported in ≥ 2 studies and also identified as statistically significant per our meta-analysis: infratentorial location and controlled systemic disease status.
Conclusion:
While PMD has a superior prognosis to LMD, it is nevertheless a critical oncologic event associated with significant mortality and remains poorly recognized. PMD is predominantly observed in patients with controlled systemic disease status and infratentorial location. Future treatment strategies should focus on reducing surgical seeding and sterilizing surgical cavities.
Insights
Pachymeningeal disease (PMD) is a pattern of brain metastasis failure after surgery and SRS. While PMD has a better prognosis than leptomeningeal disease (LMD), it requires focused treatment strategies.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Radiation Oncology
Background:
- Pachymeningeal disease (PMD) is a newly recognized pattern of brain metastasis (BrM) failure after surgery and stereotactic radiosurgery (SRS).
- PMD has unique prognostic implications compared to leptomeningeal disease (LMD).
- This study reports the prevalence, prognosis, and risk factors of PMD.
Approach:
- A systematic literature search was conducted on PUBMED and Cochrane databases.
- The search covered studies published from January 2000 to June 2023.
- Meta-analysis was used to identify risk factors.
Key Points:
- Meningeal disease (MD) occurred in 16.5% of 3992 BrM patients post-surgery and SRS.
- PMD accounted for 54.6% of MD cases, with a median overall survival of 10.6 months.
- Infratentorial location and controlled systemic disease were significant risk factors for PMD.
Conclusions:
- PMD, though having a better prognosis than LMD, is a critical oncologic event.
- PMD is predominantly seen in patients with controlled systemic disease and infratentorial tumors.
- Future strategies should aim to reduce surgical seeding and sterilize surgical cavities.
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