Breast cancer leptomeningeal metastasis—the role of multimodality treatment

Rudnicka, H; Niwińska, Anna; Murawska, Magdalena

doi:10.1007/s11060-007-9340-4

Cited by 131 publications

(98 citation statements)

References 22 publications

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“…Therapeutic approaches include intrathecal chemotherapy (mainly with methotrexate), radiotherapy of the meninges, systemic chemotherapy with drugs that penetrate the CSF, and surgery to relieve increased intracranial pressure. 5 A recent study has shown that systemic chemotherapy, intrathecal chemotherapy, and whole brain radiation all have a positive impact on patient survival, while radiotherapy of the spinal meninges does not influence patient survival time. While radiotherapy and intrathecal chemotherapy were once the mainstays of LC treatment, systemic chemotherapy (utilizing drugs that can penetrate the subarachnoid space) is gaining popularity as a therapeutic option, as it treats both the meningeal carcinomatosis as well as the systemic malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous systemic chemotherapy is preferred in patients who have multiple nodules or MRI evidence of leptomeningeal enhancement, and intrathecal chemotherapy is preferred in patients with positive CSF cytology but negative MRI scans. 5 Aggressive treatment is unlikely to improve neurologic symptoms in many patients; indeed, neurologic toxicity can result, instead. In these patients, palliation may be the best option.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Metastatic Breast Cancer to the Meninges

Ross¹,

Cui²

2010

TMF

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A 44-year-old woman with a history of triple-negative breast cancer metastatic to the brain presented with changes in mental status, lower back pain, and a left facial Bell's palsy.The patient had previously been ambulatory and fully cognizant of her surroundings until one week prior to presentation when she began to exhibit progressively worsening confusion. As her mental status began to change, the patient developed new onset pain over her lumbar spine, supra-pubic area, bilateral flanks, hips, and knees. The pain was refractory to an epidural injection into her lumbar spine performed at the patient's local hospital. Other complaints included a recent onset urinary retention, weakness of the left lower extremity, a left facial Bell's palsy, and difficulty walking. On admission, the patient was taking gabapentin, citalopram, aspirin, enoxaparin, nystatin, lopressor, docusate, lorazepam, and methylprednisone. The patient was treating her pain with hydromorphone hydrochloride as needed. No other medications had recently been prescribed.Past medical history included breast cancer status post bilateral mastectomies, four cycles of chemotherapy with paclitaxel, and neo-adjuvant radiation. One month prior to presentation, the patient was found to have metastases to her brain, and underwent a left fronto-temporal craniotomy that was then followed by a course of whole brain irradiation.Upon examination, the patient was confused and had difficulty speaking and swallowing. Her temperature was 97.4˚F, her pulse was 95 beats per minute, her respiratory rate was 20 breaths per minute, and her blood pressure was 143/88 mm Hg. The patient's pulse oximetry on room air was 95%. Her pupils were anicteric and equally round and reactive to light, but a left visual field defect was noted. The patient exhibited facial nerve palsy involving the entire left side of the face. All other cranial nerves appeared intact. The patient showed diffuse myoclonic jerks in her upper extremities. Motor testing revealed 3/5 strength in the left leg and 4/5 strength in the right leg. Sensation was preserved throughout the extremities. The patient's cardiac exam was normal, and her lungs were clear to auscultation bilaterally. Her abdomen was soft and non-distended, and her legs were non-edematous. The patient's white blood cell count was 6300 cells/mm 3 with a differential of 76.3% neutrophils and 11.9% lymphocytes. Hemoglobin was 13.5 g/dL, hematocrit was 40.4%, and platelets were 229,000/ml. Electrolyte values and coagulation tests were both within normal limits. The patient's ESR was elevated at 60. Her liver function tests showed a total protein of 6.9 gm/ dl, albumin of 4.2 gm/dl, total bilirubin 1.4 mg/dl, direct bilirubin 0.6 mg/dl, AST of 33 U/L, ALT 32 U/L, and alkaline phosphatase of 82 U/L. Blood and urine cultures were negative for bacterial growth.A CT scan of the patient's spine revealed mild multilevel degenerative changes with no evidence of lytic or blastic lesions. An MRI of the spine showed no evidence of bony metastases, spinal c...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case of Metastatic Breast Cancer to the Meninges

Ross¹,

Cui²

2010

TMF

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“…Brain parenchymal metastases can be observed in 21-82% of MC. [34][35][36][37] Any stimulation of the pia mater, such as subarachnoid blood, infection and cancer can produce enhancement of MRI. Lumbar puncture itself can induce a meningeal reaction resulting in leptomeningeal enhancement, so it would be better to conduct MRI examination prior the procedure.…”

Section: Neurological Imagingmentioning

confidence: 99%

Advancements in diagnosis and treatment of meningeal carcinomatosis in solid cancer

Cui¹,

He²,

Li³

et al. 2017

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“…Conventional systemic treatment has variable penetration in the subarachnoid space depending upon the extent of the breakdown of the BBB due to tumor implants and the subjacent inflammatory phenomenon. Regardless of the BBB drug penetration, data shows that systemic chemotherapy response has a positive impact on the survival of patients with MC 55 . A randomized trial compared intrathecal and systemic chemotherapy with systemic treatment alone in breast cancer patients with MC.…”

Section: Treatmentmentioning

confidence: 99%

Meningeal carcinomatosis in solid tumors

Martins¹,

Azevedo²,

Chinen³

et al. 2011

Arq. Neuro-Psiquiatr.

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The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome. Key words: meningeal carcinomatosis, cerebrospinal fluid, meninges, chemotherapy, metastases.Carcinomatose meníngea em tumores sólidos RESUMO O acometimento leptomeníngeo por metástases tumorais pode ocorrer em tumores sólidos, sendo chamado de carcinomatose meníngea (CM), e também em doenças linfoproliferativas. Tumores de mama, pulmão e melanoma são os principais responsáveis pelos casos, e adenocarcinoma é a histologia mais frequentemente encontrada. A CM é um evento tardio na evolução da doença e caracteriza-se por sinais e sintomas neurológicos multifocais. O diagnóstico se faz pela avaliação conjunta do quadro clínico, neuroimagem e estudo do líquido cefalorraquidiano. O maior controle da doença sistêmica obtido com as novas modalidades terapêuticas e a baixa penetração de drogas no sistema nervoso central, aliados ao desenvolvimento nos métodos de neuroimagem observado nas últimas décadas, são fatores que respondem por um aumento na incidência desta apresentação. A quimioterapia intratecal é o tratamento de escolha, porém, frequentemente paliativo. O prognóstico é reservado, sendo que o melhor performance status pode selecionar um subgrupo de pacientes com melhor evolução. Palavras-Chave: carcinomatose meníngea, líquido cefalorraquidiano, meninges, quimioterapia, metástase.

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Breast cancer leptomeningeal metastasis—the role of multimodality treatment

Cited by 131 publications

References 22 publications

A Case of Metastatic Breast Cancer to the Meninges

A Case of Metastatic Breast Cancer to the Meninges

Advancements in diagnosis and treatment of meningeal carcinomatosis in solid cancer

Meningeal carcinomatosis in solid tumors

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