Radiotherapy of the Neuroaxis for Palliative Treatment of Leptomeningeal Carcinomatosis

Hermann, Brigitte; Hültenschmidt, Beatrix; Sautter-Bihl, Marie-Luise

doi:10.1007/pl00002398

Cited by 61 publications

(49 citation statements)

References 19 publications

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“…Radiotherapy has been reported to be both feasible and effective in relieving symptoms 2,23) . However, cytotoxic drugs cannot penetrate the blood-brain barrier at effective concentrations; moreover, it is difficult to use chemotherapy in many cases because poor PS of the CM patients.…”

Section: Discussionmentioning

confidence: 99%

Carcinomatous meningitis and <i>EGFR</i> mutation

Ishikawa

Yamazaki

Mio

et al. 2015

Ann. Cancer Res. Therap.

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Background: Carcinomatous meningitis (CM) in non-small cell lung cancer (NSCLC) has no standard treatment and poor prognosis, with a median survival of 4-9 weeks. Recently, NSCLC subgroups with driver mutations were identified, with mutation of epidermal growth factor receptor gene (EGFR) being the most frequent. This retrospective study investigated the frequency and characteristics of CM in EGFR-mutated patients. Methods: From April 2007 to June 2013, consecutive NSCLC patients were screened for EGFR mutations using the PNA-LNA PCR Clamp in one institution. Diagnosis of CM was based on the presence of malignant cells in cerebrospinal fluid and/or MRI detection of leptomeningeal enhancement. Incidence and clinical features of CM patients were investigated from medical records. Results: Of 1343 NSCLC patients, 387 (28.8%) harboring EGFR mutations. Thirty-five patients (2.6%) developed CM; the rate of CM in EGFR-mutated patients (25/387, 6.46%) was significantly higher than in patients lacking the mutations (10/956, 1.04%; p < 0.01). Multiplex logistic analysis indicated strong associations between CM and EGFR mutation (p < 0.0001), brain metastasis (p < 0.0001) and non-squamous cell carcinoma histology (p = 0.026). Conclusions: NSCLC patients with EGFR mutations are more likely to develop CM than those with wild EGFR.

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Section: Discussionmentioning

confidence: 99%

Carcinomatous meningitis and <i>EGFR</i> mutation

Ishikawa

Yamazaki

Mio

et al. 2015

Ann. Cancer Res. Therap.

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“…Therefore, the tumor cells in the CNS would not become tolerant to TKI because of administration of gefitinib and remain sensitive to erlotinib, which penetrates the BBB to some extent because of its relatively higher serum con- centration compared with that of gefitinib 11) . Radiotherapy for CM was reported to be both feasible and effective in relieving symptoms 1,12) , although some reports found that whole brain radiotherapy for CM in patients with NSCLC did not prolong survival 13,14) . In our two cases, whole brain radiotherapy was administered when brain metastasis was revealed, but before CM was diagnosed, And to improve the CM patients with lung cancer, EGFR-TKI treatment, especially erlotinib, combined with radiotherapy of the brain may be a therapeutic approach.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of carcinomatous meningitis with erlotinib and whole brain radiotherapy

Ishikawa

Okano

Koyama

et al. 2012

Ann. Cancer Res. Therap.

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Carcinomatous meningitis (CM) is a severe complication of lung cancer. Here, we report on two EGFR-mutated patients who attained relatively long survivals by erlotinib treatment after diagnosis of CM. The first case is a 59-year-old woman who was diagnosed as adenocarcinoma harboring an EGFR mutation (L858R); her disease was at stage IV with multiple brain metastases. The time from the initial diagnosis of lung cancer to CM was 364 days. Erlotinib was administered for 5 months, and the survival time from the diagnosis of CM was 278 days. The second case is a 60-year-old man who underwent right lower lobe lobectomy and was diagnosed as adenocarcinoma with an EGFR mutation (E746-750 deletion) and at the pathological stage IIA (pT1N2M0). Later, the disease was recurring as brain metastasis, and progressed to CM 637 days after diagnosis of lung cancer. Erlotinib was administered for 5.5 months, and the survival time from the diagnosis of CM was 281 days. These cases indicate that erlotinib is a reasonable option for the treatment of CM in EGFR-mutated patients.

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“…Since we excluded other sites of NSCLC recurrence, we decided to intensifythetreatmentagainstthissinglesiteofrelapseandperformeda combinedITchemotherapyandradiotherapy(RT),althoughthisisnota standardtreatmentinsecondaryLCinadults;onlylimitedevidencefor thisapproachispublished [1]andthetoleranceissometimesbad.ForRT preparation,MRIscansofthebrain(September25)andspinewereperformed,revealingpathologicalfindingsofthemeninges( fig.4a,b):The duraintheskullandthecervicalspinewasuniformlythickenedwithhomogeneouscontrastmediumenhancement.Additionally,fronto-parietal subduralfluidcollectionsweredetected.Thesefindingswereinterpreted asLC,althoughnoleptomeningealenhancementwaspresent.…”

Section: Case Reportmentioning

confidence: 99%

“…The outcome of patients with LC has not changed substantiallyoverthepast30years [5].EarlytreatmentwithITMTX and RT may lengthen and improve survival if the patients achieved an improvement on either CSF cytology or neurologicalstatus,orimprovementinCSFbiochemistry [1,23,25,26].InthefirststudyregardingLCexclusivelyattributableto metastaticNSCLC,theoverallsurvivalfromtheonsetofLCdirected therapy ranged from 1 to 12 months (median 5months) [15].…”

Section: Outcomementioning

confidence: 99%

See 1 more Smart Citation

Very Late and Isolated Leptomeningeal Relapse of a Pulmonary Adenocarcinoma Presenting as Dementia

et al. 2011

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Radiotherapy of the Neuroaxis for Palliative Treatment of Leptomeningeal Carcinomatosis

Abstract: Craniospinal radiotherapy is feasible and effective for palliative treatment of leptomeningeal carcinomatosis. As far as the small patient number permits any definite conclusions, combined modality treatment seems superior to irradiation alone.

Cited by 61 publications

References 19 publications

Carcinomatous meningitis and <i>EGFR</i> mutation

Carcinomatous meningitis and <i>EGFR</i> mutation

Successful treatment of carcinomatous meningitis with erlotinib and whole brain radiotherapy

Very Late and Isolated Leptomeningeal Relapse of a Pulmonary Adenocarcinoma Presenting as Dementia

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