Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Abstract

Background: Leptomeningeal metastasis (LM) is a devastating complication of advanced cancer. Despite aggressive therapy survival is very poor. Methods: Data of all breast cancer patients with LM were retrospectively analyzed (n = 27). Results: Median survival was 9 weeks. Patients with contrast-enhancing meningeal lesions (n = 11) detected by MRI had a median survival of 33 weeks versus 8 weeks for patients without contrast-enhancing lesions (n = 9; p = 0.0407). Patients who received systemic chemotherapy (n = 18) had a median survival of 15 weeks versus 7 weeks (n = 9; p = 0.0106). Patients undergoing radiotherapy (n = 8) had a median survival of 17 weeks as compared to 5 weeks for patients without radiotherapy (n = 18; p = 0.0188). In a multiple Cox regression analysis, lack of systemic therapy (hazard ratio, HR 89.5; p = 0.002) and negative hormone receptor status (HR 4.2; p = 0.027) emerged as significant main risk factors, together with contrast-enhancing lesion as effect modifier for systemic therapy (p = 0.03). Conclusion: Contrast-enhancing meningeal lesions, systemic therapy, and radiotherapy were significantly associated with longer survival. Patients with contrast-enhancing lesions who were treated systemically had the longest survival. Evidence is increasing that systemic therapy plays an important role and should be applied in breast cancer patients with LM.

Intradural Extramedullary Metastasis of the Upper Thoracic Spine – Case Report and Literature Review

“…16 Upon occurrence of IEM, the average survival of patients is about 7.5 months and survivors are about 10% -22%. 4,9,12,14 Postoperative outcome in our patient confirm literature statement that surgical resection of IEM improves patient's quality of life by reducing the pain intensity and improving the neurological status. 12,17…”

“…They result from advanced primary neoplastic disease and most often originate from lung or breast adenocarcinoma, similarly as in the described case. 4,5,9,10 IEMs present a significant neurological complication of systemic neoplasms ranging from 3% to 43% according to clinical and autopsy studies, with only 0.8% -3.9% being symptomatic. 2,[9][10][11] Infiltration of tumor cells in the intradural space is possible via cerebrospinal fluid dissemination from brain metastases, via haematogenous pathway (arterial or via Batson venous plexus), via direct invasion of spinal cord sheaths or via the lymphatic perineural ducts.…”

“…4,5,9,10 IEMs present a significant neurological complication of systemic neoplasms ranging from 3% to 43% according to clinical and autopsy studies, with only 0.8% -3.9% being symptomatic. 2,[9][10][11] Infiltration of tumor cells in the intradural space is possible via cerebrospinal fluid dissemination from brain metastases, via haematogenous pathway (arterial or via Batson venous plexus), via direct invasion of spinal cord sheaths or via the lymphatic perineural ducts. 12 In the present case, the infiltration of the metastasis in the intradural space is Although patients with malignancies live longer due to the contemporary development of the treatment, spinal metastases impair their quality of life and shorten survival span.…”

Neoplastic Meningitis Due to Lung, Breast, and Melanoma Metastases

“…6,7 Prolonged survival of 1 year or more may be observed in 7% to 24% of patients with breast cancer and neoplastic meningitis. 33, [35][36][37]54,60,68 In breast cancer, multivariate analyses have demonstrated an association between survival and histological characteristics (grade and HR status), performance status, extent of systemic disease, treatment (number of prior chemotherapy regimens, receipt of combined treatment modalities, coadministration of systemic chemotherapy, and intra-CSF administration of chemotherapy), and initial response to treatment. 13,31,33,[35][36][37][54][55][56] In lung cancer, multivariate analyses confirm that performance status, treatment (systemic therapy and intra-CSF administration of chemotherapy), and response to neoplastic meningitis-directed therapy were associated with longer survival.…”

Neuroradiology of Leptomeningeal Metastases

“…39,47,48 In a retrospective case series, Chamberlain analyzed the MRI data of 165 patients with solid tumor LM, among whom 125 patients had positive CSF cytology and 40 had negative CSF cytology. [51][52][53][54][55][56][57][58][59][60][61][62] In a retrospective study, MRI results of pretreatment brain and spine imaging were correlated with survival in 240 patients with LM. 48 Abnormalities found by brain MRI and consistent with LM were more frequent in cytology-negative solid tumor patients versus cytology-positive solid tumor patients (80 vs 40%, p = 0.03).…”