Clinical Outcome of Neoplastic Meningitis Associated with Breast Cancer

Abstract

Background Neoplastic meningitis (NM) is considered as a terminal event with poor prognosis. Its impact in clinical oncology is growing. Objective To analyze the clinical outcome of patients with carcinoma breast diagnosed with NM. Materials and Methods This study was an observational study in breast cancer patients diagnosed with NM. Patients with typical clinical symptoms and signs with either presence of cerebrospinal fluid (CSF) cytology positive for neoplastic cells or typical radiological features of leptomeningeal involvement in the presence of neurological symptoms or signs were taken as leptomeningeal metastasis (LM) or NM. The estimation of survival was done by Kaplan–Meier method. Results Out of 1,200 patients diagnosed with carcinoma breast during the study period, 15 developed NM. The median age of study population was 51 (range: 44–55) years. Most common presentations were headache (47%), vomiting (47%), diplopia (20%), seizure (20%), and cerebellar signs (7%). Seven (46%) patients were hormone receptor positive, four (30%) were HER2 (Human epidermal growth factor receptor 2) positive and seven (46%) were triple-negative breast cancer. Median time to develop LM from the time of diagnosis of breast cancer was 6 (range: 3–8) months. Nine patients (90%) had features of NM in CSF cytology. Thirteen patients received palliative whole brain radiotherapy (20 Gy in five fractions). Nine out of 12 patients received single-agent Capecitabine as first-line chemotherapy after palliative radiation therapy (RT). Intrathecal methotrexate was given for seven patients. The median overall survival was 3 (range: 0.5–4) months. Conclusion LM is a very aggressive metastatic disease with poor outcome. There is an unmet need for proper guidelines and an overwhelming necessity for a better focus on research for new modalities of disease in this scenario.

Treatment pattern and outcomes of leptomeningeal carcinomatosis in India – a retrospective study

“…This is reflected also in the fact that all patients in the current study already had CNS symptoms. Similar experience was reported by Abraham and colleagues in breast cancer 23 where nearly all patients were symptomatic with headache (47%), vomiting (47%), diplopia (20%), and seizure (20%) being the most common symptoms. In a large experience from prospective studies in NSCLC, the symptoms of leptomeningeal disease were symptoms of altered higher mental functions (48.4%) or seizures and Headache and dizziness (32.2%).…”

“…In a LMC experience reported from Kochi (State of Kerala), the commonest site leading to LMC was breast (45%) followed by lung cancer (35%). 21 Other large experiences from India (>1100 patients) by Patil and colleagues 22 and Abraham and colleagues, 23 were in lung cancer and breast cancer respectively.…”

“… 22 Similar dismal median OS of 3 months was reported in breast cancer patients from Thiruvananthapuram (State of Kerala). 23 …”

Leptomeningeal metastasis of breast cancer during neo-adjuvant chemotherapy in a 38-year-old woman: a case report

“…LM is a rare but very aggressive metastatic diagnosis with poor outcome. A recent study from India reported the median time to develop LM from the time of diagnosis of breast cancer was 6 months and the median overall survival (OS) was 3 months ( 3 ). This case report reported a 38-year-old woman developed LM during neo-adjuvant chemotherapy.…”