Brain Tumor Research and Treatment

The Korean Brain Tumor Society (대한뇌종양학회)
권호 표지
DOI QR코드

DOI QR Code

A Retrospective Analysis of the Clinical Outcomes of Leptomeningeal Metastasis in Patients with Solid Tumors

  • Kim, Hyojeong (Department of Hemato-Oncology, Pusan University Hospital) ;
  • Lee, Eun Mi (Department of Internal Medicine, Kosin University Gaspel Hospital)
  • Received : 2018.08.18
  • Accepted : 2018.09.18
  • Published : 2018.10.31
⟨ Previous Next ⟩

Abstract

Background Leptomeningeal metastasis (LM) is an uncommon, but devastating complication of advanced cancer and has no standard treatment. Herein, we analyzed the clinical characteristics and outcomes of patients with solid tumors who were diagnosed with LM. Methods Between January 2007 and December 2017, we retrospectively analyzed the medical records of patients with solid tumors who were diagnosed with LM. Results A total of 58 patients were enrolled in this study. The median age of patients was 51 years (range, 27-72 years), and 62.1% had a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) (>2). The common types of primary tumor were breast cancer (39.7%), gastric cancer (25.9%), and non-small cell lung cancer (20.7%). Forty-two patients (72.4%) were diagnosed with LM by MRI of the brain and/or spine and cerebrospinal fluid (CSF) analysis, 14 were diagnosed by CSF analysis alone, and 2 were diagnosed by MRI alone. Treatments for LM were performed in 53 patients (91.4%), and best supportive care was provided for 5 patients (8.6%). Intrathecal chemotherapy, radiotherapy, and systemic chemotherapy were administered in 43 (74.1%), 17 (29.3%), and 24 (41.4%) patients, respectively. The median overall survival of the entire cohort was 2.4 months (95% confidence interval, 1.0-3.7). In the analysis of prognostic factors for survival, a good ECOG PS (${\leq}2$), administration of systemic chemotherapy after LM diagnosis, and a prior history of brain radiation were associated with prolonged survival. Conclusion Although the prognosis of LM in patients with solid tumors is poor, systemic chemotherapy might improve survival in selected patients with a good PS.

Keywords

References

  1. Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol 1978;19:579-92.
  2. Wasserstrom WR, Glass JP, Posner JB. Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 1982;49:759-72. https://doi.org/10.1002/1097-0142(19820215)49:4<759::AID-CNCR2820490427>3.0.CO;2-7
  3. Pavlidis N. The diagnostic and therapeutic management of leptomeningeal carcinomatosis. Ann Oncol 2004;15 Suppl 4:iv285-91. https://doi.org/10.1093/annonc/mdh941
  4. Taillibert S, Laigle-Donadey F, Chodkiewicz C, Sanson M, Hoang-Xuan K, Delattre JY. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol 2005;75:85-99. https://doi.org/10.1007/s11060-004-8101-x
  5. Herrlinger U, Forschler H, Kuker W, et al. Leptomeningeal metastasis: survival and prognostic factors in 155 patients. J Neurol Sci 2004;223:167-78. https://doi.org/10.1016/j.jns.2004.05.008
  6. Waki F, Ando M, Takashima A, et al. Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors. J Neurooncol 2009;93:205-12. https://doi.org/10.1007/s11060-008-9758-3
  7. Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM. Leptomeningeal metastases in the MRI era. Neurology 2010;74:1449-54. https://doi.org/10.1212/WNL.0b013e3181dc1a69
  8. Oechsle K, Lange-Brock V, Kruell A, Bokemeyer C, de Wit M. Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis. J Cancer Res Clin Oncol 2010;136:1729-35. https://doi.org/10.1007/s00432-010-0831-x
  9. Pentheroudakis G, Pavlidis N. Management of leptomeningeal malignancy. Expert Opin Pharmacother 2005;6:1115-25. https://doi.org/10.1517/14656566.6.7.1115
  10. Chamberlain MC. Combined-modality treatment of leptomeningeal gliomatosis. Neurosurgery 2003;52:324-29. https://doi.org/10.1227/01.NEU.0000043929.31608.62
  11. Du C, Hong R, Shi Y, Yu X, Wang J. Leptomeningeal metastasis from solid tumors: a single center experience in Chinese patients. J Neurooncol 2013;115:285-91. https://doi.org/10.1007/s11060-013-1228-x
  12. Kwon J, Chie EK, Kim K, et al. Impact of multimodality approach for patients with leptomeningeal metastases from solid tumors. J Korean Med Sci 2014;29:1094-101. https://doi.org/10.3346/jkms.2014.29.8.1094
  13. Glantz MJ, Cole BF, Glantz LK, et al. Cerebrospinal fluid cytology in patients with cancer: minimizing false-negative results. Cancer 1998;82:733-9. https://doi.org/10.1002/(SICI)1097-0142(19980215)82:4<733::AID-CNCR17>3.0.CO;2-Z
  14. Prommel P, Pilgram-Pastor S, Sitter H, Buhk JH, Strik H. Neoplastic meningitis: how MRI and CSF cytology are influenced by CSF cell count and tumor type. ScientificWorldJournal 2013;2013:248072.
  15. Hyun JW, Jeong IH, Joung A, Cho HJ, Kim SH, Kim HJ. Leptomeningeal metastasis: clinical experience of 519 cases. Eur J Cancer 2016;56:107-14. https://doi.org/10.1016/j.ejca.2015.12.021
  16. Palma JA, Fernandez-Torron R, Esteve-Belloch P, et al. Leptomeningeal carcinomatosis: prognostic value of clinical, cerebrospinal fluid, and neuroimaging features. Clin Neurol Neurosurg 2013;115:19-25. https://doi.org/10.1016/j.clineuro.2012.03.048
  17. Brower JV, Saha S, Rosenberg SA, Hullett CR, Ian Robins H. Management of leptomeningeal metastases: prognostic factors and associated outcomes. J Clin Neurosci 2016;27:130-7. https://doi.org/10.1016/j.jocn.2015.11.012
  18. Chamberlain MC, Johnston SK, Glantz MJ. Neoplastic meningitis-related prognostic significance of the Karnofsky performance status. Arch Neurol 2009;66:74-8.
  19. Freilich RJ, Krol G, DeAngelis LM. Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol 1995;38:51-7. https://doi.org/10.1002/ana.410380111
  20. Boogerd W, van den Bent MJ, Koehler PJ, et al. The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study. Eur J Cancer 2004;40:2726-33. https://doi.org/10.1016/j.ejca.2004.08.012
  21. Lee DW, Lee KH, Kim JW, Keam B. Molecular targeted therapies for the treatment of leptomeningeal carcinomatosis: current evidence and future directions. Int J Mol Sci 2016;17:1074. https://doi.org/10.3390/ijms17071074
  22. Liao BC, Lee JH, Lin CC, et al. Epidermal growth factor receptor tyrosine kinase inhibitors for non-small-cell lung cancer patients with leptomeningeal carcinomatosis. J Thorac Oncol 2015;10:1754-61. https://doi.org/10.1097/JTO.0000000000000669

Cited by

  1. Palliative approach to leptomeningeal carcinomatosis in oesophagogastric junction cancer vol.12, pp.10, 2018, https://doi.org/10.1136/bcr-2019-230114
  2. PA- and NP-led Ommaya clinics to manage leptomeningeal carcinomatosis vol.34, pp.12, 2021, https://doi.org/10.1097/01.jaa.0000800264.81721.3d