Frequent development of leptomeningeal carcinomatosis in patients with peritoneal dissemination of gastric cancer

Emoto, Shigenobu; Ishigami, Hironori; Yamaguchi, Hironori; Yamashita, Hiroharu; Kaisaki, Shoichi; Kitayama, Joji

doi:10.1007/s10120-011-0064-y

Cited by 14 publications

(7 citation statements)

References 21 publications

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“…Secondary systemic metastases preceding the onset of spine LMs were detected in 39 patients (54.9%), most frequently occurring in the brain parenchyma (38.9%) and/or regional lymph nodes (18.1%). Metastatic peritoneal seeding was described in 4 patients with gynecological neoplasms (22,50,51,63) and 1 patient with gastric adenocarcinoma (27). While primary tumors were treated with variable cancer-specific multidisciplinary strategies including surgery, adjuvant chemotherapy, and radiation, brain metastases were preferentially treated with conventional or stereotactic radiotherapy (66.7%) and/or surgical resection when feasible (60%).…”

Section: Resultsmentioning

confidence: 99%

Leptomeningeal Metastases of the Spine: A Systematic Review

et al. 2022

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Background/Aim: Leptomeningeal metastases (LMs) of the spine have complex management. We reviewed the literature on spine LMs. Materials and Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of spine LMs. Results: We included 46 studies comprising 72 patients. The most frequent primary tumors were lung (19.4%) and breast cancers (19.4%). Median time from primary tumors was 12 months (range=0-252 months). Cauda equina syndrome occurred in 34 patients (48.6%). Nodular spine LMs (63.6%) were more frequent. Concurrent intracranial LMs were present in 27 cases (50.9%). Cerebrospinal fluid cytology was positive in 31 cases (63.6%). Cases were managed using palliative steroids (73.6%) with locoregional radiotherapy (55.6%) chemotherapy (47.2%), or decompressive laminectomy (8.3%). Post-treatment symptom improvement (32%) and favorable radiological response (28.3%) were not different based on treatment (p=0.966; p=0.727). Median overallsurvival was 3 months (range=0.3-60 months), not significantly different between radiotherapy and chemotherapy (p=0.217). Conclusion: Spine LMs have poor prognoses. Radiotherapy, chemotherapy, and surgery are only palliative, as described for intracranial LMs.Leptomeningeal metastases (LMs) are late-stage complications of systemic malignancies, occurring approximately in 5-10% of patients with solid and hematologic neoplasms (1, 2). Frequently manifesting with new neurological deficits, LMs may be detected at T1-contrast MRI follow-ups as nodular or diffuse meningeal enhancement, and may be confirmed with high-volume cerebrospinal fluid (CSF) taps for cytology (3,4). Several systemic therapeutic options are available, but the treatment goal remains palliation, as mean survival ranges 3-6 months (3,5,6).LMs involving the spine represent unique entities that may severely impact patients' functional status (7, 8). While diffuse spinal LMs may remain clinically silent and go undetected, nodular spinal LMs frequently compress spinal nerve roots causing radicular pain or neurological impairments (2, 9). Nodular spinal LMs may also lead to acute or progressive cauda equina syndrome, which require urgent diagnosis and management (10,11). While surgical decompression may provide prompt symptomatic relief, patients may not be good candidates due to their significant tumor burden (2, 3). In these cases, locoregional radiation, chemotherapy, and other systemic treatments may be pursued to achieve similar clinical outcomes (12, 13).Although spinal LMs pose significant challenges in the oncological care of patients with systemic metastases, only 619 This article is freely accessible online.

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Section: Resultsmentioning

confidence: 99%

Leptomeningeal Metastases of the Spine: A Systematic Review

et al. 2022

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“…Also whole-brain radiation is often performed for LMC patients to palliate their symptoms, decrease bulky disease, and correct CSF flow abnormalities. [8] 30-36 Gy in 3 Gy daily fractions is recommended by several studies. [17,18] CSF drainage is also performed to relieve the symptoms of elevated intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, anticonvulsants should not be used as prophylactic and reserved for patients with seizures. Emoto and colleagues [8] reported that in patients with poor prognostic factors such as poor performance status or MRI-proven LMC, palliative therapy may be the most suitable treatment strategy. In addition, the clinical efficacy of IT MTX in conjunction with RT is illustrated by several study.…”

Section: Discussionmentioning

confidence: 99%

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Leptomeningeal Carcinomatosis in a Krukenberg Tumor Associated with Signet Ring Cell Gastric Cancer

Başgöz¹

2016

TJ Oncol

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SUMMARYLeptomeningeal carcinomatosis (LCM) is a rare complication of gastric cancer. It usually occurs late in advanced stage of disease and is sometimes misdiagnosed as toxicity of chemotherapeutic agents. Here we report a rare case of gastric cancer that developed LCM in follow-up. A 28-year-old woman with signet ring cell gastric cancer associated with Krukenberg tumor was admitted with persistent headache, nausea, vomiting, vertigo, and diplopia. Linear appearance of contrast enhancement in cerebellar fissures and around cranial nerves was seen in magnetic resonance imaging and cerebrospinal fluid was hypercellular with numerous carcinoma cells. LMC was confirmed and treated with intrathecal methotrexate and additional whole-brain irradiation. LCM is a rare complication, but occurs more often than expected and is often misdiagnosed. If patient who is being treated for gastric cancer presents with neurological symptoms, LCM should be kept in mind. Clinical improvement can be achieved with current treatment modalities, including radiotherapy, chemotherapy, or targeted molecules.

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“…Clinical studies investigating the effects of intraperitoneal chemotherapy with paclitaxel (PTX) performed by our group on such patients have shown that the treatment is well tolerated and effective [ 1 – 3 ]. Moreover, we have experienced rare cases of metastasis and recurrence recently, such as leptomeningeal carcinomatosis [ 4 ] after long-term control of peritoneal metastasis. Particularly, bone marrow metastasis is highly rare in gastric cancer [ 5 ], and disseminated carcinomatosis of the bone marrow (DCBM) is known to be closely associated with disseminated intravascular coagulation (DIC) and a poor prognosis [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A case of disseminated carcinomatosis of the bone marrow originating from gastric cancer 3 years after intraperitoneal chemotherapy against peritoneal carcinomatosis

et al. 2016

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BackgroundClinical studies of intraperitoneal chemotherapy with paclitaxel in patients of gastric cancer with peritoneal carcinomatosis is well tolerated and effective, and rare cases of metastasis and recurrence have experienced during the treatment. Disseminated carcinomatosis of the bone marrow is highly rare in gastric cancer and associated with a poor prognosis.Case presentationA 59-year-old woman of gastric cancer with peritoneal carcinomatosis received five courses of chemotherapy with intraperitoneal administration of paclitaxel, and laparoscopy showed disappearance of the peritoneal carcinomatosis. She subsequently underwent total gastrectomy, and the histopathological findings showed a complete response to the chemotherapy. Postoperatively, chemotherapy with intraperitoneal administration of paclitaxel was continued for 30 months, without apparent recurrence. However, the gastric cancer recurred as disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation, and we hence changed the chemotherapy regimen to weekly irinotecan. Remission was achieved, and she did not experience any major symptoms; however, she died 6 months after the diagnosis of disseminated carcinomatosis of the bone marrow.ConclusionsSince intraperitoneal paclitaxel administration can strongly suppress peritoneal carcinomatosis of gastric cancer, careful attention should be paid not only to peritoneal recurrence but also for rare site metastases, such as bone marrow metastases.

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Frequent development of leptomeningeal carcinomatosis in patients with peritoneal dissemination of gastric cancer

Cited by 14 publications

References 21 publications

Leptomeningeal Metastases of the Spine: A Systematic Review

Leptomeningeal Metastases of the Spine: A Systematic Review

Leptomeningeal Carcinomatosis in a Krukenberg Tumor Associated with Signet Ring Cell Gastric Cancer

A case of disseminated carcinomatosis of the bone marrow originating from gastric cancer 3 years after intraperitoneal chemotherapy against peritoneal carcinomatosis

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