The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study

Boogerd, Willem; Bent, Martin J. van den; Koehler, Peter J.; Heimans, J. J.; Sande, J.J. van der; Aaronson, N.K.; Hart, A.A.M.; Benraadt, J.; Vecht, Ch.J.

doi:10.1016/j.ejca.2004.08.012

Cited by 254 publications

(192 citation statements)

References 26 publications

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“…This might explain why in our series as well as in the series of Herrlinger et al [17] the presence of contrast-enhancing lesions is a good prognostic factor in systemically treated patients. To our knowledge there is only one published prospective randomized trial comparing intra-CSF treatment with non-intra-CSF treatment [18]. However, there is increasing evidence that systemic therapy might be efficacious in LM.…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Regierer

Stroux

Kühnhardt³

et al. 2008

Breast Care

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Background: Leptomeningeal metastasis (LM) is a devastating complication of advanced cancer. Despite aggressive therapy survival is very poor. Methods: Data of all breast cancer patients with LM were retrospectively analyzed (n = 27). Results: Median survival was 9 weeks. Patients with contrast-enhancing meningeal lesions (n = 11) detected by MRI had a median survival of 33 weeks versus 8 weeks for patients without contrast-enhancing lesions (n = 9; p = 0.0407). Patients who received systemic chemotherapy (n = 18) had a median survival of 15 weeks versus 7 weeks (n = 9; p = 0.0106). Patients undergoing radiotherapy (n = 8) had a median survival of 17 weeks as compared to 5 weeks for patients without radiotherapy (n = 18; p = 0.0188). In a multiple Cox regression analysis, lack of systemic therapy (hazard ratio, HR 89.5; p = 0.002) and negative hormone receptor status (HR 4.2; p = 0.027) emerged as significant main risk factors, together with contrast-enhancing lesion as effect modifier for systemic therapy (p = 0.03). Conclusion: Contrast-enhancing meningeal lesions, systemic therapy, and radiotherapy were significantly associated with longer survival. Patients with contrast-enhancing lesions who were treated systemically had the longest survival. Evidence is increasing that systemic therapy plays an important role and should be applied in breast cancer patients with LM.

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Section: Discussionmentioning

confidence: 99%

Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Regierer

Stroux

Kühnhardt³

et al. 2008

Breast Care

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“…In a retrospective comparison of patients treated with systemic chemotherapy and radiation to involved areas, with or without intrathecal chemotherapy, Bokstein et al [74] did not find significant differences in response rates, the median survival time, or the proportion of long-term survivors among the two groups, but of course, the group that did not receive the intrathecal treatment was spared the complications of this modality. Boogerd et al [75], in a small, prospective, randomized phase II study of patients with breast cancer and NM, suggested no benefit to intra-CSF chemotherapy when compared with symptomatic therapy, including involved-field radiotherapy and systemic chemotherapy. That study, however, was flawed by poor balancing between known prognostic features affecting survival in patients with NM.…”

Section: Chemotherapymentioning

confidence: 99%

Neoplastic Meningitis

2008

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After completing this course, the reader should be able to:1. Describe the epidemiology of leptomeningeal metastasis.2. Participate in the diagnosis of leptomeningeal metastasis. Engage in the treatment of leptomeningeal metastasis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground: Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer.Methods: Notwithstanding frequent focal signs and symptoms, NM is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments.Results: Central nervous system staging of NM includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging or computerized tomographic myelography and radionuclide CSF flow study. Treatment of NM incorporates involved-field radiotherapy of bulky or

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“…The median survival was 18.3 weeks in the IT arm and 30.3 weeks in the non-IT arm, although no statistical significance was achieved. Neurological complications related to treatment occurred more commonly IT arm (47% vs 6%) 56 . Despite a poor therapeutic index for use in solid tumors, methotrexate and cytarabine in high doses as used occasionally in high grade lymphomas and leukemias, give therapeutic CSF levels.…”

Section: Treatmentmentioning

confidence: 99%

“…Use of concomitant glucocorticoids with the chemotherapy reduces the risk and intensity of the inflammation. There is a report of improving subacute myelopathy caused by intrathecal methotrexate when high doses of S-adenosilmethionine (200 mg, iv three times per day), folinic acid (20 mg, iv four times per day), cyanocobalamin (100 mg, once daily) and methionine (5 g, once daily orally) were supplemented 56 . Acute paraplegia is a rare complication described with use of triple therapy including methotrexate, cytarabine, and thiotepa.…”

Section: Complications Of Treatmentmentioning

confidence: 99%

Meningeal carcinomatosis in solid tumors

Martins¹,

Azevedo²,

Chinen³

et al. 2011

Arq. Neuro-Psiquiatr.

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The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome. Key words: meningeal carcinomatosis, cerebrospinal fluid, meninges, chemotherapy, metastases.Carcinomatose meníngea em tumores sólidos RESUMO O acometimento leptomeníngeo por metástases tumorais pode ocorrer em tumores sólidos, sendo chamado de carcinomatose meníngea (CM), e também em doenças linfoproliferativas. Tumores de mama, pulmão e melanoma são os principais responsáveis pelos casos, e adenocarcinoma é a histologia mais frequentemente encontrada. A CM é um evento tardio na evolução da doença e caracteriza-se por sinais e sintomas neurológicos multifocais. O diagnóstico se faz pela avaliação conjunta do quadro clínico, neuroimagem e estudo do líquido cefalorraquidiano. O maior controle da doença sistêmica obtido com as novas modalidades terapêuticas e a baixa penetração de drogas no sistema nervoso central, aliados ao desenvolvimento nos métodos de neuroimagem observado nas últimas décadas, são fatores que respondem por um aumento na incidência desta apresentação. A quimioterapia intratecal é o tratamento de escolha, porém, frequentemente paliativo. O prognóstico é reservado, sendo que o melhor performance status pode selecionar um subgrupo de pacientes com melhor evolução. Palavras-Chave: carcinomatose meníngea, líquido cefalorraquidiano, meninges, quimioterapia, metástase.

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The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study

Cited by 254 publications

References 26 publications

Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Neoplastic Meningitis

Meningeal carcinomatosis in solid tumors

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