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

Abstract

BackgroundLeptomeningeal 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.MethodsBetween January 2007 and December 2017, we retrospectively analyzed the medical records of patients with solid tumors who were diagnosed with LM.ResultsA 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.ConclusionAlthough the prognosis of LM in patients with solid tumors is poor, systemic chemotherapy might improve survival in selected patients with a good PS.

Impact of clinicopathologic features on leptomeningeal metastasis from lung adenocarcinoma and treatment efficacy with epidermal growth factor receptor tyrosine kinase inhibitor

“…Moreover, in subgroup analysis of EGFR‐TKIs, there was no significant difference in OS between erlotinib and gefitinib (8.7 months [95% CI 5.0–12.3 months] vs. 8.5 months [95% CI 5.1–11.9 months], P = 0.608; data not shown). This survival benefit was observed in patients with ECOG PS ≤2 and controlled extracranial disease, consistent with previous studies . Moreover, of 62 patients treated with EGFR‐TKIs, 11 (17.7%) received third‐generation EGFR‐TKIs, and the survival outcomes in these patients were significantly longer than with other treatments, including first‐generation EGFR‐TKIs and cytotoxic chemotherapy.…”

Palliative approach to leptomeningeal carcinomatosis in oesophagogastric junction cancer

“…Common metastatic sites are liver and peritoneum 1. However, due to increased survival with new treatments, LC incidence is rising 3 7…”

“…PS at diagnosis of LC is the most important prognostic factor 5. While patients with good PS can endure aggressive treatments, including ChT, only 27% of patients with ECOG PS3–4 or Karnofsky score below 60% receive IT ChT and these present a survival around 2 months 7 14–16. Besides minor survival benefit, treatment also implies economic costs, invasive procedures and frequent admissions.…”

“…Moreover, prolonged survival with treatment in LC is usually achieved in breast and lung cancer, while other solid cancers show very poor prognosis 5 7. Other poor prognostic factors include age over 50 years, major neurological deficits, high burden central nervous system (CNS) disease and high protein level in CSF 6 14 15.…”

“…Besides palliative care, treatment strategies are RT, IT ChT and systemic ChT 6 7 14 17. Selection factors for these include good PS and younger age 6.…”