Brain Tumor Res Treat.  2018 Oct;6(2):54-59. 10.14791/btrt.2018.6.e12.

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

• Kim H
• Lee EM

• KMID: 2423974
• DOI: http://doi.org/10.14791/btrt.2018.6.e12

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 (≤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.

Keyword

Leptomeningeal carcinomatosis; Cerebrospinal fluid; Chemotherapy

MeSH Terms

Brain
Breast Neoplasms
Carcinoma, Non-Small-Cell Lung
Cerebrospinal Fluid
Cohort Studies
Diagnosis
Drug Therapy
Humans
Magnetic Resonance Imaging
Medical Records
Meningeal Carcinomatosis
Neoplasm Metastasis*
Prognosis
Radiotherapy
Retrospective Studies*
Spine
Stomach Neoplasms

Figure

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  Fig. 1 Kaplan-Meier curve of survival since the diagnosis of LM. LM, leptomeningeal metastasis; CI, confidence interval.

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  Fig. 2 Kaplan-Meier curve of survival according to (A) the PS at diagnosis of LM, (B) a prior history of brain radiation, and (C) administration of systemic chemotherapy after diagnosis of LM. PS, performance status; LM, leptomeningeal metastasis; OS, overall survival; CTx, chemotherapy.

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