Meningeal carcinomatosis in breast cancer: prognostic factors and outcome

Abstract

Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27-76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03-90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients.

Advancements in diagnosis and treatment of meningeal carcinomatosis in solid cancer

“…Vertigo presented in 12 patients (20%). [14] Classically, MC presents with various clinical signs and symptoms in three domains of neurologic function: the cerebral hemispheres; the cranial nerves; and the spinal cord and associated roots. [15] Headache, nausea, vomiting are the most frequent manifestations of cerebral hemisphere dysfunction.…”

Leptomeningeal carcinomatosis as the primary presentation of relapse in breast cancer

“…These results are consistent with the hypothesis that the majority of breast cancer patients who exhibit LM present with systemic disease at diagnosis, with 25% of patients exhibiting LM as the only site of distant metastasis. Previous studies have reported that in 9-15% of breast cancer patients, LM is the first presentation of metastasis (11,14). However, data that demonstrates the frequency of LM as the first presentation of relapse following breast cancer treatment is limited and thus, only a comparative assessment of such studies was performed.…”

Tratamento de Carcinomatose Meníngea por Quimioterapia Intratecal Através de Catéter Reservatório de Ommaya: Experiência de um Centro Neurocirúrgico

“…O prognóstico desta complicação é reservado, com sobrevidas médias reportadas de 6 -7 semanas, 6 podendo estender-se até aos 3,3 -4,5 meses em subgrupos mais favoráveis. 7,8 O melhor tratamento para esta forma de metastização não é consensual. O prognóstico inerente à CM e as complicações neurológicas associadas podem fazer do tratamento paliativo a melhor abordagem em muitas situações.…”

“…6,7,8 Este facto pode ser explicado por um viés de selecção no sentido dos doentes com melhor prognóstico e por uma melhoria no tratamento da doença oncológica. As características demográficas reflectem esse viés de selecção, mostrando um predomínio do tumor da mama e uma distribuição demográfica com predomínio do sexo feminino na idade adulta (55,5 ± 2,6 anos).…”

“…No entanto, após a realização de ajustamento para os fatores de confundimento identificados, apenas a origem do tumor primitivo mostrou significância estatística, estando a mama associado a melhor prognóstico. Este achado é suportado por outras séries da literatura 5,7,8,19 e poderá justificar as diferenças encontradas na análise não ajustada no que se refere ao género.…”