Leptomeningeal carcinomatosis: Prognostic value of clinical, cerebrospinal fluid, and neuroimaging features

Palma, Jose‐Alberto; Fernández‐Torrón, Roberto; Esteve-Belloch, Patricia; Fontes-Villalba, Ariadna; Hernández, A; Fernández-Hidalgo, Óscar; Pérez-Larraya, Jaime Gállego; Vilà, E.

doi:10.1016/j.clineuro.2012.03.048

Cited by 40 publications

(44 citation statements)

References 34 publications

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“…However, several previous studies have indicated that age, a poor PS score, a time between primary tumor and LC diagnosis of 12 months or less, and coexistent bulky metastatic disease in the CNS are negative prognostic factors. 4,14,15 However, these reports were limited due to the inclusion of varied types of cancer patients with LMC or small sample sizes.…”

Section: Discussionmentioning

confidence: 98%

Icotinib might be effective for the treatment of leptomeningeal carcinomatosis in non-small cell lung cancer with sensitive EGFR mutations

et al. 2015

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Section: Discussionmentioning

confidence: 98%

Icotinib might be effective for the treatment of leptomeningeal carcinomatosis in non-small cell lung cancer with sensitive EGFR mutations

et al. 2015

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“…For instance, although the authors reported excellent 18 and 14 month median OS in two small subgroups receiving I TT or TKI , the median OS was only 3 months in the whole study cohort of Morris et al [6], which was comparable to our finding of 3.9 months. Besides the use of highly aggressive treatment options, several other prognostic factors including the presentation with high PS, female gender, absence of encephalopathy, low protein-high glucose levels in cerebrospinal fluid, mutant EGFR gene status, controlled primary tumor, longer TT-LMC, and absence of parenchymal BM were also related to better survival outcomes [19][20][21][22]. In accordance with and lending support to these studies, our results showed the ECOG PS, absence of parenchymal BM, and TT-LMC from the NSCLC diagnosis as independent indicators of superior OS.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the fact that the prognostic value of the TT-LMC was analyzed by various investigators [17,23], to our knowledge, the present study was the first to assign a significant prognostic value to this variable in pure NSCLC patients treated exclusively with WBRT. Compared to 11.3 months, Palma et al [21] reported that patients with TT-LMC > 67 weeks (15.6 months) had significantly longer OS. While comparison between our study and an investigation by Palma was difficult only 24 % of the patients had lung cancers and only 5 % of patients received WBRT among the whole study population [21], the clear association between longer TT-LMC and better survival was common between the two studies.…”

Section: Fig 2 Overall Survival In 51 Patientsmentioning

confidence: 96%

“…Compared to 11.3 months, Palma et al [21] reported that patients with TT-LMC > 67 weeks (15.6 months) had significantly longer OS. While comparison between our study and an investigation by Palma was difficult only 24 % of the patients had lung cancers and only 5 % of patients received WBRT among the whole study population [21], the clear association between longer TT-LMC and better survival was common between the two studies.…”

Section: Fig 2 Overall Survival In 51 Patientsmentioning

confidence: 96%

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Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

2016

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To assess the efficacy of whole-brain radiotherapy (WBRT) and prognostic factors in leptomeningeal carcinomatosis (LMC) of non-small-cell lung cancer (NSCLC) patients. WBRT records of 51 LMC patients confined to brain were reviewed. Eligible patients had squamous-cell carcinoma (SCC) or adenocarcinoma, and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-3. The WBRT was either 20 or 30 Gray. The primary and secondary objectives were to determine overall survival (OS) and prognostic factors for improved treatment response, respectively. Median age was 53 years (range 39-68), 58.8 % had SCC, 74.5 % had ECOG PS 1-2, and 70.6 % had LMC accompanied by parenchymal brain metastases (BM). The median follow-up was 4.1 months (range 0.7-14.4); all patients died due to disease progression. Median OS was 3.9 months (95 % CI 3.3-4.5) with 6 and 12 month estimates of 19.6 and 5.9 %, respectively. Evaluation of prognostic factors revealed that patients with ECOG 1, longer time to LMC (TT-LMC) from NSCLC diagnosis (>11.3 months), and absence of parenchymal BM had significantly superior OS than those patients with ECOG 2 (p = 0.01) or 3 (p < 0.001), TT-LMC < 11.3 months (p = 0.001), and parenchymal BM (p = 0.012). Median OS of 3.9 months after WBRT appeared to confirm the poor prognosis of LMC. WBRT might be most effective for patients with favorable PS, longer TT-LMC, and no accompanying BM. Therefore, we identified ECOG PS 1, TT-LMC > 11.3 months, and no BM as independent prognosticators for better response to WBRT in NSCLC patients with LMC.

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“…Because MC is considered the terminal stage of the disease, concurrent chemoradiation has no impact on patient outcome, but can improve clinical symptoms. [15] In this study, the clinical manifestations of 77 patients are diverse, but most of them are characterized by increased intracranial pressure symptoms such as headache, nausea and vomit. Therefore, when patients have above symptoms, we should be vigilant about MC and improve the head MRI and enhanced MRI scan, if necessary.…”

Section: Discussionmentioning

confidence: 99%

Meningeal carcinomatosis: a retrospective analysis of seventy-seven cases

Chu¹,

Lang²,

Sun³

et al. 2017

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Aim: Meningeal carcinomatosis is a special type of malignant tumor characterized by short survival and poor prognosis. In the present study, the authors aim to analyze the clinical, laboratory data and prognosis of meningeal carcinomatosis patients. Methods: The authors enrolled 77 cases of meningeal carcinomatosis from 2003 to 2013 in the First Hospital of Jilin University. The clinical data including age, gender, symptoms at onset, clinical manifestations, primary tumors and the laboratory data including cerebrospinal fluid (CSF), tumor markers as well as the imaging data were analyzed. The interval between the onset of primary tumor and the onset of central nervous symptoms, treatments and survival time were also analyzed. Results: The onset of meningeal carcinomatosis was usually acute (46.2%) or subacute (39.0%). The most frequent symptom at onset was intracranial hypertension (70.1%). Symptoms such as headache, vomit and high lumbar puncture intracranial pressure was observed in 56% of cases during the course of the disease. CSF abnormalities such as higher protein concentration (73.4%), more CSF pleocitosis (57.1%) and lower glucose levels (48.4%) were found in 95.3% of meningeal carcinomatosis patients. Non-contrast enhanced cerebral magnetic resonance imaging (MRI) showed that 13.2% patients had abnormal meningeal changes while in the enhancement scan 35.3% patients showed changes. The serum tumor markers increased in 84% of the patients. There were no differences regarding the mean survival between patients who received intrathecal chemotherapy and those who received brain radiotherapy or supportive treatment. Conclusion: The most common clinical manifestation of meningeal carcinomatosis is intracranial hypertension. The most common primary tumor is lung cancer, followed by gastric cancer and breast cancer. The linear enhancement of meningeal on the MRI scan is of great importance for the diagnosis of meningeal carcinomatosis. Key words:Meningeal carcinomatosis, cerebrospinal fluid, magnetic resonance imaging, therapy ABSTRACTArticle history:

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Leptomeningeal carcinomatosis: Prognostic value of clinical, cerebrospinal fluid, and neuroimaging features

Cited by 40 publications

References 34 publications

Icotinib might be effective for the treatment of leptomeningeal carcinomatosis in non-small cell lung cancer with sensitive EGFR mutations

Icotinib might be effective for the treatment of leptomeningeal carcinomatosis in non-small cell lung cancer with sensitive EGFR mutations

Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors

Meningeal carcinomatosis: a retrospective analysis of seventy-seven cases

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