Leptomeningeal metastasis from solid tumors: a diagnostic and therapeutic challenge

Abstract

Leptomeningeal metastasis (LM) is a severe complication in the natural history of malignancies that occurs in 4-15 % of patients (pts) with solid tumors. Clinical presentation, cerebrospinal fluid cytology (CSF), and gadolinium magnetic resonance imaging (gdMRI) of the brain and spine are the methods routinely used to diagnose LM. Treatment encompasses involved-field radiotherapy of bulky or symptomatic disease sites and chemotherapy; however, no standard therapy has been established yet. We collected and reviewed retrospectively the clinical, pathological, radiological findings as well as the outcomes of 50 consecutive patients with LM from solid tumors to determine whether the diagnostic modalities and therapeutic procedures affected the outcomes. The results of this study confirm the role of gdMRI in the diagnosis of LM in clinical practice and suggest that an aggressive treatment may improve survival in patients with this debilitating and increasingly frequent neurological complication.

The clinical characteristic and prognostic factors of leptomeningeal metastasis in patients with non‐small‐cell lung cancer‐a retrospective study from one single cancer institute

“…We identified smoking was an independent predictor of poor survival; the median OS for non‐smokers was longer than that of current or former smokers (12.7 vs 6.7 months, P = 0.005). Age and gender have been considered to be prognostic factors for survival in previous studies, but this was not the case in our study as we registered no significant difference.…”

Outcomes and clinical features of leptomeningeal carcinomatosis: A single center experience

“…In recent studies, m OS after LMC diagnosis ranged from 0.7 months to 4.8 months [9][10][11][12][13][14], in our study m OS was 1.5 months which was similar to literature. Clinical presentation with cerebral symptoms were the most common symptoms in conformity with the literature [7,12,14]. But, in our study nature of the clinical symptoms were not found to have prognostic effect as Giglio et al's study [2].…”

“…Whereas, LMC was mostly seen in breast cancer patients in Western countries [7,9,10,12,14], Asian studies reported that LMC occurred most frequently in lung cancer patients [11,13]. Consistent with Asian studies, in our study, lung cancer was the most frequent type of cancer and breast cancer was the second most common one seen in LMC patients.…”

Gadobutrol-enhanced magnetic resonance imaging of meningeal carcinomatosis: case report with emphasis on early diagnosis

“…Cranial nerve palsies resulting in diplopia, facial paralysis can also occur. These non-specific symptoms may be the initial signs in patients without tumor history [6]. Therefore the diagnosis of MC sometimes becomes extremely difficult in the early stage.…”

“…The gold diagnosis standard is CSF cytology with the specificity of about 95 % for MC [6]. However, nearly 50 % patients are cytologically negative on the first lumber puncture examination.…”