Radiation Therapy in the Management of Leptomeningeal Disease From Solid Tumors

Barbour, Andrew B.; Kotecha, Rupesh; Lazarev, Stanislav; Palmer, Joshua D.; Robinson, Timothy; Yerramilli, Divya; Yang, Jonathan T.

doi:10.1016/j.adro.2023.101377

Cited by 5 publications

(1 citation statement)

References 88 publications

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“…Leptomeningeal disease (LMD) is clinically detected in 5 to 10% of patients with solid tumors, while 20 to 30% of patients with metastatic disease and neurologic symptoms harbor LMD at autopsy [1]. While recent therapeutic advances have improved patient outcomes [2], objective tools for prognostication in patients with LMD are lacking.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of cerebrospinal fluid tumor cell count in leptomeningeal disease from solid tumors

Barbour,

Blouw,

Taylor

et al. 2024

J Neurooncol

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Purpose: Treatment decisions for leptomeningeal disease (LMD) rely on patient risk strati cation, since clinicians lack objective prognostic tools. The introduction of rare cell capture technology for identi cation of cerebrospinal uid tumor cells (CSF-TCs) improved the sensitivity of LMD diagnosis, but prognostic value is unknown. This study assesses the prognostic value of CSF-TC density in patients with LMD from solid tumors. Methods: We conducted a retrospective cohort study of patients with newly diagnosed or previously treated LMD from a single institution who had CNSide assay testing for CSF-TCs from 2020 to 2023. Univariable and multivariable survival analyses were conducted with Cox proportional-hazards modeling.Maximally-selected rank statistics were used to determine an optimal cutpoint for CSF-TC density and survival.Results: Of 31 patients, 29 had CSF-TCs detected on CNSide. Median (interquartile range [IQR]) CSF-TC density was 67.8 (4.7-639) TCs/mL. CSF cytology was positive in 16 of 29 patients with positive CNSide (CNSide diagnostic sensitivity = 93.5%, negative predictive value = 85.7%). Median (IQR) survival from time of CSF-TC detection was 176 (89-481) days. On univariable and multivariable analysis, CSF-TC density was signi cantly associated with survival. An optimal cutpoint for dichotomizing survival by CSF-TC density was 19.34 TCs/mL. The time-dependent sensitivity and speci city for survival using this strati cation were 76% and 67% at 6 months and 65% and 67% at 1 year, respectively.Conclusions: CSF-TC density may carry prognostic value in patients with LMD from solid tumors.Integrating CSF-TC density into LMD patient risk-strati cation may help guide treatment decisions.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of cerebrospinal fluid tumor cell count in leptomeningeal disease from solid tumors

Barbour,

Blouw,

Taylor

et al. 2024

J Neurooncol

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Leptomeningeal metastases from solid tumors: A Society for Neuro-Oncology and American Society of Clinical Oncology consensus review on clinical management and future directions

Wilcox,

Chukwueke,

Ahn

et al. 2024

Neuro-Oncology

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Leptomeningeal metastases are increasingly becoming recognized as a treatable, yet generally incurable, complication of advanced cancer. As modern cancer therapeutics have prolonged the lives of patients with metastatic cancer, specifically in patients with parenchymal brain metastases, treatment options and clinical research protocols for patients with leptomeningeal metastases from solid tumors have similarly evolved to improve survival within specific populations. Recent expansion in clinical investigation, early diagnosis, and drug development have given rise to new unanswered questions. These include leptomeningeal metastasis biology and preferred animal modeling, epidemiology in the modern cancer population, ensuring validation and accessibility of newer leptomeningeal metastasis diagnostics, best clinical practices with multi-modality treatment options, clinical trial design and standardization of response assessments, and avenues worthy of further research. An international group of multi-disciplinary experts in the research and management of leptomeningeal metastases, supported by the Society for Neuro-Oncology and American Society of Clinical Oncology, were assembled to reach a consensus opinion on these pressing topics and provide a roadmap for future directions. Our hope is that these recommendations will accelerate collaboration and progress in the field of leptomeningeal metastases and serve as a platform for further discussion and patient advocacy.

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Research Progress on the Mechanism of Occurrence and Treatment of Leptomeningeal Metastasis of Malignant Tumors

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2024

ACM

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Radiation Therapy in the Management of Leptomeningeal Disease From Solid Tumors

Cited by 5 publications

References 88 publications

Prognostic value of cerebrospinal fluid tumor cell count in leptomeningeal disease from solid tumors

Prognostic value of cerebrospinal fluid tumor cell count in leptomeningeal disease from solid tumors

Leptomeningeal metastases from solid tumors: A Society for Neuro-Oncology and American Society of Clinical Oncology consensus review on clinical management and future directions

Research Progress on the Mechanism of Occurrence and Treatment of Leptomeningeal Metastasis of Malignant Tumors

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