Leptomeningeal carcinomatosis

Abstract

BACKGROUND:Leptomeningeal carcinomatosis (LC) represents a devastating complication of systemic cancer, and patients with LC have a dismal prognosis and increased mortality. The few studies that have focused on the evaluation of prognostic factors in patients with LC have resulted in contradictory results. Thus, the treatment of LC remains controversial, and no straightforward guidelines exist in the literature. The objective of the current study was to identify prognostic markers related to LC survival to better select patients who are eligible for intensive treatment.METHODS:Seventy patients who had a diagnosis of LC were reviewed, and clinical data, cerebrospinal fluid (CSF) parameters, tumor‐related characteristics, and treatment information were registered. The impact of single parameters on overall survival was determined by both univariate and multivariate analyses.RESULTS:The multivariate analysis revealed that Radiation Therapy Oncology Group score ≤2 (P = .028), a glucose level in CSF ≥2.7 mmol/L (P = .001), the presence of infratentorial symptoms at onset (P = .026), and intrathecal treatment (P < .001) were associated independently with longer overall survival in patients with LC. In addition, the same clinical factors also predicted response to treatment in such patients.CONCLUSIONS:The predictive factors for patients with LC that were identified in this study could help to better select patients who are more likely to benefit from chemotherapy. Cancer 2009. © 2009 American Cancer Society.

Impact of Multimodality Approach for Patients with Leptomeningeal Metastases from Solid Tumors

“…According to manifesting symptoms, Boogerd et al (15) and Balm et al (18) demonstrated that patients with symptoms related to cranial nerve or cerebral involvement had worse prognosis, respectively. However the relationship between symptoms and outcomes was conflicted with each other studies (15, 16, 19). Although the neuraxis imaging study is one of most important diagnostic tools for LM, it is unclear whether extent of CNS infiltration on imaging study affects the survival.…”

“…In the past, IT-CTx was considered as the main treatment modality in LM, whereas the role of Sys-Tx was questioned due to belief that intravenously injected chemotherapeutic agents was unavailing because of BBB (13). Thus, older studies mainly focused on validating the role of IT-CTx (18, 19, 20, 22, 23). Recently, however, the role of IT-CTx has been questioned.…”

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

“…It is therefore remarkable that little consensus exists amongst different laboratories about the reference ranges for CSF glucose and lactate [1]. CSF glucose is decreased in, amongst others, patients with bacterial meningitis and leptomeningeal carcinomatosis, usually in combination with other abnormal CSF parameters, such as an elevated leucocyte count, total protein or lactate concentration [2]–[4]. Low CSF glucose, often in combination with low CSF lactate, can also be found in patients with GLUT1 deficiency syndrome, a treatable genetic metabolic disorder that is caused by impaired glucose transport into brain [5].…”

Application of 3D Fast Spin-Echo T1 Black-Blood Imaging in the Diagnosis and Prognostic Prediction of Patients with Leptomeningeal Carcinomatosis

“…proper treatment can prevent the deterioration of neurologic symptoms that impair the patient's quality of life. 1,6 Therefore, early diagnosis and proper treatment of LC are the most important strategies to improve the overall survival and quality of life of patients with LC.…”