A systematic review of craniospinal irradiation for leptomeningeal disease: past, present, and future

Maillie, Luke; Salgado, L.; Lazarev, Stanislav

doi:10.1007/s12094-021-02615-8

Cited by 7 publications

(6 citation statements)

References 56 publications

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“…A recently published review summarized 13 studies, including a total of 275 patients treated with CSI for LC of different histologies (the most common being leukemia and BC) [ 60 ]. The median CSI dose was 30 Gy, and 18% of patients received PT.…”

Section: Resultsmentioning

confidence: 99%

Radiotherapy for Leptomeningeal Carcinomatosis in Breast Cancer Patients: A Narrative Review

Pawłowska

Romanowska

Jassem

2022

Cancers

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Leptomeningeal carcinomatosis (LC), defined as the infiltration of the leptomeninges by cancer cells, is a rare oncological event with the most common etiology being breast cancer (BC), lung cancer, and melanoma. Despite innovations in radiotherapy (RT), firm evidence of its impact on survival is lacking, and concerns are related to its possible neurotoxicity. Owing to a paucity of data, the optimal treatment strategy for LC remains unknown. This review discusses current approaches, indications, and contraindications for various forms of RT for LC in BC. A separate section is dedicated to new RT techniques, such as proton therapy. We also summarize ongoing clinical trials evaluating the role of RT in patients with LC.

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Section: Resultsmentioning

confidence: 99%

Radiotherapy for Leptomeningeal Carcinomatosis in Breast Cancer Patients: A Narrative Review

Pawłowska

Romanowska

Jassem

2022

Cancers

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“…CSI trials involved small patient numbers with a heterogeneous cancer population. The most common cancers enrolled in these trials included breast, acute myeloid leukemia and lung with a median overall survival (OS) of 5.8 months [5].…”

Section: Radiation Therapymentioning

confidence: 99%

New strategies for the treatment of breast cancer with leptomeningeal metastasis

Chew,

Seidman

2023

Current Opinion in Oncology

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Purpose of review Leptomeningeal metastasis is a complication of metastatic breast cancer that has a rising incidence likely due to the increased availability of novel systemic therapies, which have improved survival with better extracranial disease control but with limited intracranial efficacy. A poor prognosis of less than 6 months has historically been associated with leptomeningeal metastasis and it is often an exclusion factor for enrollment in clinical trials. There are limited evidence-based data supporting use of therapeutics in leptomeningeal metastasis patients and recommendations are largely derived from retrospective reports and small prospective studies. However, in recent years, there has been a surge in effective modern therapeutics with promising intracranial activity. Recent findings The study aims to review the most recent updates in the management of leptomeningeal metastasis in breast cancer. We discuss the effectiveness and limitations of intrathecal administration, predictive biomarkers in the cerebrospinal fluid, proton radiation therapy and promising new systemic therapies such as antibody drug conjugates. Summary Ongoing development of clinical trials that allow inclusion of leptomeningeal metastasis are essential for establishing efficacy potential and discovering new treatment options in this population of great unmet need.

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“…Craniospinal photon irradiation of the entire neuraxis is typically not recommended considering the high risk of severe treatment-related toxicity that occurs in almost one-half of patients, including fatigue, nausea, cognitive impairment, and perhaps most importantly bone marrow suppression that limits subsequent systemic therapy as a result. [87][88][89][90][91] These significant qualityof-life-limiting toxicities must be taken into account when considering photon-based craniospinal irradiation, especially in the setting of an overall poor prognosis. Proton craniospinal irradiation has also been evaluated as a potentially less toxic option for patients with leptomeningeal disease in a 2021 randomized phase 2 study, which showed a significant improvement in the progression-free survival rate and overall survival rate as compared with conventional photon beam radiation with no increase in serious treatmentrelated adverse events and a lower likelihood of bone marrow toxicity, allowing for improved tolerability of subsequent systemic therapy.…”

Section: Key Pointmentioning

confidence: 99%

Section: Leptomeningeal Diseasementioning

confidence: 99%

Brain Metastases and Leptomeningeal Disease

Kumthekar,

Le Rhun

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE Central nervous system (CNS) metastases include brain parenchymal, spinal cord, and leptomeningeal metastases. This article discusses the diagnostic and therapeutic advances of the last decade that have improved outcomes for patients with these CNS metastases. LATEST DEVELOPMENTS The diagnostic tools for CNS metastases, particularly leptomeningeal disease, have evolved over the past decade with respect to advancements in CSF analysis. Multiple medical therapies are now available for brain metastasis treatment that have shown CNS efficacy, including targeted therapies and antibody-drug conjugates. Molecular testing for CNS metastases has become more common and the repertoire of molecularly targeted therapies continues to expand. Advancements in radiation therapy, including improvements in stereotactic radiation techniques, whole-brain radiation with hippocampal avoidance, and proton beam radiation, have changed the radiation management of patients with CNS metastases. New intrathecal agents are currently being tested for the management of leptomeningeal metastases. ESSENTIAL POINTS CNS metastases are far more common than primary brain tumors and are increasing in prevalence in the setting of improved treatments and prolonged survival in patients with systemic cancers. There have been many changes in the diagnostics and treatment of CNS metastases, yielding subsequent improvements in patient outcomes with further advancements on the horizon.

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A systematic review of craniospinal irradiation for leptomeningeal disease: past, present, and future

Cited by 7 publications

References 56 publications

Radiotherapy for Leptomeningeal Carcinomatosis in Breast Cancer Patients: A Narrative Review

Radiotherapy for Leptomeningeal Carcinomatosis in Breast Cancer Patients: A Narrative Review

New strategies for the treatment of breast cancer with leptomeningeal metastasis

Brain Metastases and Leptomeningeal Disease

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