Long-term Outcome after Multidisciplinary Approach for Leptomeningeal Carcinomatosis in a Non-small Cell Lung Cancer Patient with Poor Performance Status

Abstract

The present study describes a case of a 60-year-old Japanese man who was histologically diagnosed with lung adenocarcinoma harboring L858R mutation of epidermal growth factor receptor. He was successfully treated with gefitinib, but eventually developed leptomeningeal carcinomatosis. He underwent ventriculoperitoneal shunting for hydrocephalus and received erlotinib in place of gefitinib with concurrent whole brain radiotherapy; this resulted in dramatic improvement in his symptoms and performance status from four to one and he survived for as long as 13.6 months after the initiation of erlotinib therapy. This multidisciplinary approach may be particularly useful in terms of increasing survival and improving quality of life.

The concentration of CYFRA 21-1, NSE and CEA in cerebro-spinal fluid can be useful indicators for diagnosis of meningeal carcinomatosis of lung cancer

“…For MC patients, the type of the primary cancer is a major prognostic factor. Lung cancer patients with MC who received focal irradiation and intraventricular methotrexate, improved or remained stable within a range of 1-12 months with a median survival of 3-4 months and a 0% survival rate at 1 year [10,23]. Apart from tumor type, performance and neurological status, the bulk of CSF disease as well as the extent of systemic cancer also influence outcome in patients with MC.…”

“…Widespread dissemination of tumor cells throughout the meninges and ventricles can be seen in 5% of cases with adenocarcinoma of the breast [7], gastrointestinal tract [8], melanoma, childhood leukemia and systemic lymphoma [9]. Of the 10%-15% of patients with neurologic metastatic lung cancer, approximately 5% of patients with non-small cell lung cancer will develop MC (or metastatic infiltration of the cerebro-spinal fluid, CSF) [4,10,11].…”

A 56-year-old man with acute vision loss

“…10 The median survival of patients with this disorder is 4-6 weeks without treatment; even in response to therapy, median survival in these patients is limited to 18.6 weeks. 7,22 Early diagnosis is important, although treatment is intended to reduce the symptoms and at best extend survival, especially when neurologic symptoms are already present. 5 Because there are no well-established regimens, the treatment of meningeal carcinomatosis varies, and treatment options are very limited.…”

“…Patients with meningeal carcinomatosis have a guarded prognosis with a mean survival rate of 3-6 months. 4,5,22 …”

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

“…[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. [19] Corticosteroids is rarely effective in neurological deficits but can improve headaches better than analgesics.…”