Clinical outcomes of leptomeningeal metastasis in patients with non-small cell lung cancer in the modern chemotherapy era

Park, Jin Hyun; Kim, Yu Jung; Lee, Jeong-Ok; Lee, Keun-Wook; Kim, Jee Hyun; Bang, Soo‐Mee; Chung, Jin-Haeng; Kim, Jae Sung; Lee, Jong Seok

doi:10.1016/j.lungcan.2011.11.022

Cited by 153 publications

(146 citation statements)

References 19 publications

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“…Patients with good performance status and lesser disease burden usually benefit from treatment. Several studies have suggested that treatment does improve quality of life and prolongs survival [9,13]. …”

Section: Discussionmentioning

confidence: 99%

Bronchogenic Carcinoma Presenting as Carcinomatous Meningitis

Upadhyay¹

2017

JLPRR

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Carcinomatous meningitis is defined as metastatic infiltration of cerebrospinal fluid (CSF) and leptomeninges by cancer with primary focus at some other site. This is not so common complication of lung cancer. Bronchogenic carcinoma presenting primarily with central nervous symptoms is even more uncommon. Demonstration of neoplastic cells in the CSF is key to the diagnosis. This complication impacts on the poor survival as well as poor performance status of the cancer afflicted individual. A rare case of such a manifestation is described. Keywords: DiscussionNeoplastic meningitis is the third most common metastatic complication of central nervous system (CNS) after brain metastases and epidural spinal cord compression [1]. The diagnosis and treatment of neoplastic meningitis are of great clinical relevance due to their impact on patient quality of life and rate of survival. Such patients mostly have poor performance status with median survival of approximately two months without treatment [5]. On the other hand, incidence of neoplastic meningitis is increasing due in part to improved rates of survival, because of availability of more effective systemic agents but with poor CNS penetration [6]. Estimates from different studies quote leptomeningeal involvement in approximately 2-5% of patients with breast carcinoma, 9-25% of patients with small cell lung carcinoma (SCLC) and 23% of those with melanoma [7][8][9]. 1-3% of non-small cell lung cancer is reported to develop carcinomatous meningitis [6].The clinical presentation of neoplastic meningitis is multifocal depending on which domain of nervous system is involved. The most frequent manifestations are headache, change in mental status, gait abnormality, vomiting (cerebral hemisphere dysfunction), diplopia and facial paresis(cranial nerve involvement), lower extremity weakness and paresthesias, back or neck pain, and radiculopathy (spinal cord or exiting nerveroot manifestations) [10]. Meningissmus (neck stiffness) and seizures are uncommon presentation occurring in fewer than 15% and 10% of patients respectively [5]. Though most patients who present with carcinomatous meningitis have a past history of treated malignancy or active malignancy, some patients have their cancer diagnosed subsequent to diagnosis of carcinomatous meningitis [2]. The described case also presented primarily with neurological features. Diagnosis of carcinomatous meningitis is established by examination of cerebrospinal fluid (CSF). Demonstration of tumor cells in CSF using flow cytometry, cytospin, centrifugation, or Millipore filtering is the gold standard test. A high opening pressure (>200 mm H 2 O), elevated protein (>60 mg/dl), reduced glucose levels (<50 mg/dl) favour the diagnosis but are not conclusive. Specificity of CSF examination is high (80-95%) but sensitivity is low (below 50%). Repeat lumbar puncture(usually two attempts), generous volume(>10ml), obtaining sample from involved site, avoiding hemorrhagic sample and prompt processing increases the yield [1,5,11]. MR...

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Section: Discussionmentioning

confidence: 99%

Bronchogenic Carcinoma Presenting as Carcinomatous Meningitis

Upadhyay¹

2017

JLPRR

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“…The interval between initial cancer diagnosis and the development of LM is longer for breast cancer than in other solid tumors. Median time from initial breast cancer diagnosis to LM is 3 ½ years [4], compared to one year or less for lung cancer [5].…”

Section: Discussionmentioning

confidence: 99%

Leptomeningeal Metastases in Solid Tumors

Karakolevska-Ilova

Joveva

Ivanova

2014

Open Access Maced J Med Sci

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“…Brain parenchymal metastases can be observed in 21-82% of MC. [34][35][36][37] Any stimulation of the pia mater, such as subarachnoid blood, infection and cancer can produce enhancement of MRI. Lumbar puncture itself can induce a meningeal reaction resulting in leptomeningeal enhancement, so it would be better to conduct MRI examination prior the procedure.…”

Section: Neurological Imagingmentioning

confidence: 99%

“…[60][61][62] Therapeutic effects in patients treated with intrathecal injection may be superior to those without IT treatment (P = 0.001). [34,35] Bone marrow suppression can occur after administration of intrathecal chemotherapies, which will be relieved after rescue with folinic acid (10 mg every 6 h for 24 h). Intra-CSF chemotherapy usually produces transient (< 5 days) chemical aseptic meningitis that manifest as fever, headache, nausea/ vomiting, photophobia, meningismus and insanity, which may be mitigated by oral medications such as febrifuges, antemetics, and steroids in most cases.…”

Section: Intrathecal Therapymentioning

confidence: 99%

Advancements in diagnosis and treatment of meningeal carcinomatosis in solid cancer

Cui¹,

He²,

Li³

et al. 2017

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Clinical outcomes of leptomeningeal metastasis in patients with non-small cell lung cancer in the modern chemotherapy era

Cited by 153 publications

References 19 publications

Bronchogenic Carcinoma Presenting as Carcinomatous Meningitis

Bronchogenic Carcinoma Presenting as Carcinomatous Meningitis

Leptomeningeal Metastases in Solid Tumors

Advancements in diagnosis and treatment of meningeal carcinomatosis in solid cancer

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