The clinical outcomes of leptomeningeal metastasis and intrathecal MTX in patients with gastric cancer: A retrospective analysis

Abstract

Aim: The aim of this study was to report the clinical features of patients with LM originating from gastric cancer and the outcomes of intrathecal (IT) chemotherapy with methotrexate (MTX) in these patients.
 Method: This study analyzed retrospectively the medical records of 10 patients with gastric cancer, who were diagnosed with LM and received IT chemotherapy with MTX at Kosin University Gospel Hospital between January 2007 and December 2017.
 Results: Of 10 patients, half was male and the median age at LM diagnosis was 49 years (rang, 33–72). All patients but one had a poor performance status. Seven patients had poorly differentiated or signet ring cell adenocarcinomas, and six had Borrmann type III or IV gastric cancer. The median time from diagnosis of gastric cancer to the development of LM was 22.6 months (range, 4.93–103.7). LM was detected by brain magnetic resonance imaging in 6 patients, and was established in cerebrospinal fluid (CSF) analysis in all 10 patients. IT MTX for LM was administrated in all 10 patients, and the median 6 cycles of IT MTX was performed (range, 1–35). Three patients achieved negative conversion of malignant cytology in CSF. Systemic chemotherapy was performed in 5 patients. The median survival time from LM diagnosis was 2.1 months (95% confidence interval [CI], 1.5–2.7). Two patients survived about 12 months after LM diagnosis.
 Conclusion: Although the prognosis of LM in gastric cancer patients was poor, the administration of IT MTX might have clinical benefit in some selected patients.