Lepto maniacs.

Post-op brain radiosurgery (SRS) to minimize leptomeningeal disease (LMD) is apparently quite the hot topic. Here we have one of the largest series yet, this time from Stanford, that includes 442 patients treated with CyberKnife SRS for over 500 resected brain metastases. Most patients (>75%) were treated with 8 Gy x 3, most using a 1-3 mm margin around the cavity. At 12 months, the rate of LMD was 13% overall. They used recent consensus definitions of nodular and classic LMD, and just over half of LMD recurrences were nodular. LMD was highest (~20%) for those with breast histology and/or infratentorial tumor location. The cumulative local failure rare was 7%, and the distant intracranial failure rate was 37%. TBL: This large series confirms an overall low rate of LMD recurrence and favorable rate of local control with SRS to brain met resection cavities. | Shi, Int J Radiat Oncol Biol Phys 2019