Leptomeningeal carcinomatosis as the primary presentation of relapse in breast cancer

Abstract

Abstract. Leptomeningeal metastasis (LM) is an uncommon presentation of relapse in breast cancer, which is associated with poor clinical outcomes and poor prognosis. Notably, LM most commonly occurs in breast cancer. The aim of the present review was to investigate the occurrence of LM as the primary presentation of relapse following remission in breast cancer patients and to determine whether specific histological subtypes are predisposed to meningeal metastases. In addition, the present review evaluated whether patients presenting with LM as the primary site of relapse exhibit differences in survival when compared with patients exhibiting metastasis to other sites. Cross-sectional studies have demonstrated that LM is commonly associated with other sites of distant metastasis including lung, liver and bone metastases. The histological breast cancer subtype most commonly associated with LM was invasive lobular carcinoma, while triple-negative breast cancer patients appear to be predisposed to the development of LM when considering the overall prevalence of histological breast cancer subtypes. At present, data regarding LM as the primary site of relapse are limited due to its rarity as the first site of metastasis in breast cancer. Case-controlled studies are required to investigate the incidence of LM as the primary site of recurrence in breast cancer patients as this would enable treatment standardization and identification of prognostic factors for improved survival.

Leptomeningeal Disease as an Initial Presenting Manifestation in Breast Cancer

“…LMD occurs in ≤5% of breast cancer patients. It usually occurs at the advanced stage of the disease and may occur as the first presentation of metastasis in 9-15% of patients diagnosed with breast cancer [ 3 ]. Rarely, patients can present with LMD at diagnosis without previously known breast cancer as in our case [ 4 , 5 ].…”

“…Current treatment modalities recommended for breast cancer patients with LMD are intrathecal chemotherapy, radiation therapy to the affected area, and approaches to decrease the intracranial pressure [ 3 ]. Treatment involves multidisciplinary care with symptom management and pain control, and therapies are given with palliative intent.…”

6 Cases of Breast Cancer-Associated Neoplastic Meningitis and Literature Review

“…The most common manifestations of spinal cord involvement are fatigue, pee and stool dysfunction, limb paresthesia, neck or back radiculopathy and pain. Neck stiffness is present in less than 15% of MC patients [7,14,15] . Others can also show the in ammatory response of NM.…”

“…The median survival time of patients diagnosed with MC is 4.27 months (0.11-3.78), and 23% of patients have a survival time of more than 1 year after diagnosis of MC. Related studies have shown that invasive ductal carcinoma is prone to parenchymal brain metastasis, while invasive lobular carcinoma is prone to meningeal metastasis [15] . Autopsy data from patients with metastatic breast cancer show that the incidence of MC in invasive lobular breast cancer is about 14%, while that in invasive ductal breast cancer is 1% [16] .…”

Durable Effect of Pyrotinib and Metronomic Vinorelbine in HER2-Positive Breast Cancer With Leptomeningeal Disease: A Case Report and Literature Review

“…Of all the subtypes, Human epidermal growth factor receptor 2 (HER2)-positive BC has a predilection for brain metastasis but is less likely to develop LM at the same time (7). Previous studies have reported that the frequency of HER2-positive BC among LM patients ranges between 14%-29% (8)(9)(10)(11)(12).…”