Clinical Features and Prognostic Factors in Patients with Carcinomatous Meningitis Secondary to Breast Cancer

Abstract

Prognosis in patients with carcinomatous meningitis (CM) is poor, and numerous prognostic factors for response and survival have been described, but remain controversial. In general, series are small and involve a heterogeneous type of solid neoplasms. The purpose of this study was to describe a series of patients with breast cancer-associated CM to determine the clinical features and prognostic factors associated with survival. We conducted a retrospective study on 49 patients diagnosed between January 2003 and December 2007 at the Instituto Nacional de Cancerología in Mexico City. CSF cytopathology samples were re-reviewed to confirm the diagnosis. Overall survival (OS) for patients with breast cancer with CM was 7 weeks. Factors independently associated with better OS included absence of encephalopathy at diagnosis (11 weeks versus 1 week; p = .036), low CSF protein content (15 versus 5 weeks; p = .022), and nontriple-negative receptor status in the primary breast cancer tumor (13 versus 3 weeks; p = .015). According to multivariate analysis, patients were divided into favorable and poor prognostic groups, with OS of 14 weeks and 2 weeks, respectively (p < .001). These factors can identify a subgroup of patients who are candidates for an intensive management approach.

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

“…16,19,20 Of these, headache is the most common among all 3 anatomical areas of the CNS. 16,19,20 These symptoms are attributed to high intracranial pressure and may be associated with papilledema. Headaches are often described as worse when awakening or lying down and can interfere with sleep.…”

“…In a study of leptomeningeal metastases from breast cancer and a study of neoplastic meningitis due to several different primary tumors, researchers found that the median Karnofsky performance status was approximately 70%. 8,16 …”

“…8,14,15 Paresis or paralysis was the initial finding in 41% of patients presenting with neoplastic meningitis secondary to breast cancer and is a commonly seen symptom. 8,14,16 At our clinic, 1 patient presented with painful, unprovoked muscle spasms who, after investigation, was diagnosed with neoplastic meningitis.…”

“…19 Other patients present with seizure and altered mental status. 13,16 Nausea and vomiting represent the most common symptom cluster following headache. 8,16 Symptoms are frequently related to intracranial pressure, either with or without evidence of an actual block to the flow of CSF or direct meningeal irritation.…”

“…3,6,[8][9][10][12][13][14][15][16][17][18] Cerebral Symptoms Cerebral symptoms include headache, dizziness/vertigo, confusion, fatigue, gait instability, aphasia, altered mental status, seizure (although rare), hemiparesis, and numbness. 16,19,20 Of these, headache is the most common among all 3 anatomical areas of the CNS. 16,19,20 These symptoms are attributed to high intracranial pressure and may be associated with papilledema.…”