Analysis of Treatment Outcomes of Intraventricular Chemotherapy in 105 Patients for Leptomeningeal Carcinomatosis from Non–Small-Cell Lung Cancer

Gwak, Ho-Shin; Joo, Jungnam; Kim, Sohee; Yoo, Heon; Shin, Sang Hoon; Han, Ji‐Youn; Kim, Heung Tae; Lee, Jin Soo; Lee, Jun Young

doi:10.1097/jto.0b013e318287c943

Cited by 79 publications

(86 citation statements)

References 30 publications

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“…I n the LMC literature, generally most patients were reported to survive only 3-4 months after the diagnosis with exceptional longer survival reports of up to 2 years [6,[16][17][18]. For instance, although the authors reported excellent 18 and 14 month median OS in two small subgroups receiving I TT or TKI , the median OS was only 3 months in the whole study cohort of Morris et al [6], which was comparable to our finding of 3.9 months.…”

Section: Discussionsupporting

confidence: 91%

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Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

2016

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To assess the efficacy of whole-brain radiotherapy (WBRT) and prognostic factors in leptomeningeal carcinomatosis (LMC) of non-small-cell lung cancer (NSCLC) patients. WBRT records of 51 LMC patients confined to brain were reviewed. Eligible patients had squamous-cell carcinoma (SCC) or adenocarcinoma, and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-3. The WBRT was either 20 or 30 Gray. The primary and secondary objectives were to determine overall survival (OS) and prognostic factors for improved treatment response, respectively. Median age was 53 years (range 39-68), 58.8 % had SCC, 74.5 % had ECOG PS 1-2, and 70.6 % had LMC accompanied by parenchymal brain metastases (BM). The median follow-up was 4.1 months (range 0.7-14.4); all patients died due to disease progression. Median OS was 3.9 months (95 % CI 3.3-4.5) with 6 and 12 month estimates of 19.6 and 5.9 %, respectively. Evaluation of prognostic factors revealed that patients with ECOG 1, longer time to LMC (TT-LMC) from NSCLC diagnosis (>11.3 months), and absence of parenchymal BM had significantly superior OS than those patients with ECOG 2 (p = 0.01) or 3 (p < 0.001), TT-LMC < 11.3 months (p = 0.001), and parenchymal BM (p = 0.012). Median OS of 3.9 months after WBRT appeared to confirm the poor prognosis of LMC. WBRT might be most effective for patients with favorable PS, longer TT-LMC, and no accompanying BM. Therefore, we identified ECOG PS 1, TT-LMC > 11.3 months, and no BM as independent prognosticators for better response to WBRT in NSCLC patients with LMC.

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Section: Discussionsupporting

confidence: 91%

“…The prognostic impact of parenchymal BM in LMC patients is an area of active research [16,25,26]. Particular to LMC of NSCLC, parenchymal BM is present in more than 50 % of cases.…”

Section: Fig 2 Overall Survival In 51 Patientsmentioning

confidence: 99%

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

2016

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“…In order to palliate LMrelated neurological symptoms, WBRT is occasionally effective, but does not appear to provide a relevant survival benefit [6]. A few retrospective studies suggested effectiveness of intrathecal chemotherapies, but no clear evidence has been confirmed by prospective trials [7,8]. Unfortunately, few established therapeutic options are administered for NSCLC complicated with LM without driver oncogene…”

Section: Introductionmentioning

confidence: 98%

High-dose erlotinib for refractory leptomeningeal metastases after failure of standard-dose EGFR-TKIs

Kawamura

Hata

Takeshita

et al. 2015

Cancer Chemother Pharmacol

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“…In the treatment of LC, surgery and radiotherapy have only a limited role and they are mainly deserved for palliation of hydrocephalus or symptoms resulting from focal lesions, whereas intrathecal or systemic chemotherapy are more widely used (77). Although some retrospective studies suggested an improvement in symptomatic palliation and a survival benefit with intrathecal chemotherapy for LC (76,78), the optimal dose and schedule as well as the real efficacy of intrathecal chemotherapy remain elusive, due to the lack of large randomized clinical trials (74).…”

Section: Chemotherapy As Salvage Treatment For Progressive Bmsmentioning

confidence: 99%

State of the art of chemotherapy for the treatment of central nervous system metastases from non-small cell lung cancer

Inno¹,

Noia²,

D’Argento³

et al. 2016

Transl. Lung Cancer Res.

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Chemotherapy is the mainstay of treatment of advanced non-small cell lung cancer (NSCLC) without molecular drivers. Despite a low penetration of central nervous system (CNS), chemotherapy drugs demonstrated encouraging activity against CNS metastases from NSCLC. Based on the available data, chemotherapy should be considered as an important part of the multidisciplinary treatment of CNS metastases. Particularly, platinum-based regimens represent the most active combinations and pemetrexed is associated with a meaningful clinical benefit for patients with non-squamous histology. How to integrate chemotherapy and radiotherapy for newly diagnosed brain metastases (BMs) is still debated. Although flawed by some limitations, the available evidence suggests a role for upfront chemotherapy for the treatment of NSCLC patients with synchronous, asymptomatic BMs, thus allowing a delay of radiotherapy. Despite the introduction of modern and more effective chemotherapy, however, the prognosis of NSCLC patients with CNS metastases remains poor, especially for those with progressive BMs or leptomeningeal carcinomatosis (LC).

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Analysis of Treatment Outcomes of Intraventricular Chemotherapy in 105 Patients for Leptomeningeal Carcinomatosis from Non–Small-Cell Lung Cancer

Cited by 79 publications

References 30 publications

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

High-dose erlotinib for refractory leptomeningeal metastases after failure of standard-dose EGFR-TKIs

State of the art of chemotherapy for the treatment of central nervous system metastases from non-small cell lung cancer

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