{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:02:26Z","timestamp":1791349346270,"version":"4.3.1"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T00:00:00Z","timestamp":1539820800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and\/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine &amp; Gray model. Overall survival was analyzed using the Kaplan-Meier method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.015), cystic features (HR 2.34,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.013), breast histology (HR 3.23,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.016), and number of brain metastases &gt;1 (HR 2.09,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.032) were independently associated with increased risk of LMD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyy436","type":"journal-article","created":{"date-parts":[[2018,8,19]],"date-time":"2018-08-19T23:20:53Z","timestamp":1534720853000},"page":"632-641","source":"Crossref","is-referenced-by-count":34,"title":["Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery"],"prefix":"10.1227","volume":"85","author":[{"given":"Robert H","family":"Press","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudit","family":"Chowdhary","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Rush University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan S","family":"Prabhu","sequence":"additional","affiliation":[{"name":"Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Ferris","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J","family":"Olson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bree R","family":"Eaton","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Kuo G","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter J","family":"Curran","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian R","family":"Crocker","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirtesh R","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Therapeutic Radiology, Smilow Cancer Center, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,11]]},"reference":[{"issue":"17","key":"bib1-20231012","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1001\/jama.280.17.1485","article-title":"Postoperative radiotherapy in the treatment of single metastases to the brain","volume":"280","author":"Patchell","year":"1998","journal-title":"JAMA"},{"issue":"2","key":"bib2-20231012","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijrobp.2011.12.009","article-title":"Stereotactic radiosurgery of the 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