Leptomeningeal metastases in glioma

Abstract

ObjectiveTo perform a retrospective analysis examining the incidence and prognosis of glioma patients with leptomeningeal disease (LMD) at Memorial Sloan Kettering Cancer Center over a 15-year period and correlate these findings with clinicopathologic characteristics.MethodsWe conducted a retrospective review of glioma patients with LMD at Memorial Sloan Kettering Cancer Center diagnosed from 2001 to 2016. Patients were identified through a keyword search of their electronic medical record and by ICD-9 codes.ResultsOne hundred three patients were identified with disseminated LMD and 85 patients with subependymal spread of disease, 4.7% of all patients with glioma. These cohorts were analyzed separately for time to development of disseminated LMD/subependymal LMD, median overall survival, and survival from LMD diagnosis. Patients were pooled for subsequent analyses (n = 188) because of comparable clinical behavior. LMD was present at glioma diagnosis in 10% of patients. In the remaining 90% of patients diagnosed at recurrence, time to LMD diagnosis, survival after LMD diagnosis, and overall survival varied by original histology. Patients with oligodendroglioma had a median survival of 10.8 (range 1.8–67.7) months, astrocytoma 6.5 (0.1–28.5) months, and glioblastoma 3.8 (0.1–32.6) months after LMD diagnosis. In addition, we found that treatment of LMD was associated with superior performance status and increased survival.ConclusionPatients with LMD diagnosed at relapse may not have decreased overall survival as compared to historical controls with parenchymal relapse and may benefit from treatment.

Classification of Progression Patterns in Glioblastoma: Analysis of Predictive Factors and Clinical Implications

“…Although the majority of GBM cases suffer local failure, non-local progression can be also encountered in clinical practice and still shows a clear upward trend in recent years (5)(6)(7)(8)23). The reported rate of non-local progression of GBM at first recurrence ranges from 2% to 34.5% (5)(6)(7)(8)(24)(25)(26)(27)(28)(29)(30)(31). In the present study, 61 (24.7%) patients developed non-local progression which was in accordance with prior studies (28,30,31).…”

“…Tumor progression seems to be an inevitable outcome in terms of the current treatment status of GBM. Although the majority of GBM cases suffer local failure, non-local progression can be also encountered in clinical practice and still shows a clear upward trend in recent years (5)(6)(7)(8)23). The reported rate of non-local progression of GBM at first recurrence ranges from 2% to 34.5% (5)(6)(7)(8)(24)(25)(26)(27)(28)(29)(30)(31).…”

“…Brandes et al reported that patients with recurrence out of radiation field conferred a longer survival than those showing recurrence within radiation field, which was attributed to the improved local control (6). However, non-local failure is commonly considered as a sign of advanced stage of GBM and indicates a worse prognosis (7,10,35). Therefore, considering the contradictory results on the definition and implication of progression patterns, we divided the progression pattern of GBM into local and non-local subtypes based on clear and easily replicable criteria, which could contribute to addressing these controversies.…”

“…According to the previous studies, about 80% GBM cases would suffer progression within primary treatment field (5,6). However, patients with different progression patterns, including distant metastasis and leptomeningeal spread, have been increasingly reported in recent years (7,8). It's noteworthy that there is no broad consensus on the classification of patients' progression patterns (9).…”

“…It's noteworthy that there is no broad consensus on the classification of patients' progression patterns (9). Furthermore, controversy still remains regarding the clinical implication of different progression patterns (6,7,10).…”