TY - JOUR
T1 - Assessment of Leptomeningeal Carcinomatosis Diagnosis, Management and Outcomes in Patients with Solid Tumors Over a Decade of Experience
AU - Rinehardt, Hannah
AU - Kassem, Mahmoud
AU - Morgan, Evan
AU - Palettas, Marilly
AU - Stephens, Julie A.
AU - Suresh, Anupama
AU - Ganju, Akansha
AU - Lustberg, Maryam
AU - Wesolowski, Robert
AU - Sardesai, Sagar
AU - Stover, Daniel
AU - Vandeusen, Jeffrey
AU - Cherian, Mathew
AU - del Pilar Guillermo Prieto Eibl, Maria
AU - Miah, Abdul
AU - Alnahhas, Iyad
AU - Giglio, Pierre
AU - Puduvalli, Vinay K.
AU - Ramaswamy, Bhuvaneswari
AU - Williams, Nicole
AU - Noonan, Anne M.
N1 - Publisher Copyright:
© 2021 Eur J Breast Health. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Objective: Leptomeningeal carcinomatosis (LMC), a common complication of advanced malignancies, is associated with high morbidity and mortality, yet diagnosis and treatment decisions remain challenging. This study describes the diagnostic and treatment modalities for LMC and identifies factors associated with overall survival (OS). Materials and Methods: We performed a single-institution retrospective study (registration #: OSU2016C0053) of 153 patients diagnosed with LMC treated at The Ohio State University, Comprehensive Cancer Center, (OSUCCC)-James between January 1, 2010 and December 31, 2015. Results: Median age at diagnosis was 55.7 years, and 61% had Eastern Cooperative Oncology Group baseline performance status ≤1. Most common primary tumors were breast (43%), lung (26%), and cutaneous melanoma (10%). At presentation, most patients were stage III-IV (71%) with higher grade tumors (grade III: 46%). Metastases to bone (36%), brain (33%), and lung (12%) were the most common sites with a median of 0.5 years (range, 0-14.9 years) between the diagnosis of first metastasis and of LMC. 153 (100%) patients had MRI evidence of LMC. Of the 67 (44%) who underwent lumbar puncture (LP), 33 (22%) had positive cerebrospinal fluid (CSF) cytology. Most patients received radiotherapy for LMC (60%) and chemotherapy (93%) for either the primary disease or LMC. 28 patients received intrathecal chemotherapy, 22 of whom had a primary diagnosis of breast cancer. 98% died with median OS of all patients was 1.9 months (95% CI: 1.3-2.5 months). Conclusion: Despite improved treatments and targeted therapies, outcomes of LMC remain extremely poor. Positive CSF cytology was associated with lower OS in patients who had cytology assessed and specifically in patients with breast cancer. CSF cytology serves as an important indicator for prognosis and helps aid in developing individualized therapeutic strategies for patients with LMC.
AB - Objective: Leptomeningeal carcinomatosis (LMC), a common complication of advanced malignancies, is associated with high morbidity and mortality, yet diagnosis and treatment decisions remain challenging. This study describes the diagnostic and treatment modalities for LMC and identifies factors associated with overall survival (OS). Materials and Methods: We performed a single-institution retrospective study (registration #: OSU2016C0053) of 153 patients diagnosed with LMC treated at The Ohio State University, Comprehensive Cancer Center, (OSUCCC)-James between January 1, 2010 and December 31, 2015. Results: Median age at diagnosis was 55.7 years, and 61% had Eastern Cooperative Oncology Group baseline performance status ≤1. Most common primary tumors were breast (43%), lung (26%), and cutaneous melanoma (10%). At presentation, most patients were stage III-IV (71%) with higher grade tumors (grade III: 46%). Metastases to bone (36%), brain (33%), and lung (12%) were the most common sites with a median of 0.5 years (range, 0-14.9 years) between the diagnosis of first metastasis and of LMC. 153 (100%) patients had MRI evidence of LMC. Of the 67 (44%) who underwent lumbar puncture (LP), 33 (22%) had positive cerebrospinal fluid (CSF) cytology. Most patients received radiotherapy for LMC (60%) and chemotherapy (93%) for either the primary disease or LMC. 28 patients received intrathecal chemotherapy, 22 of whom had a primary diagnosis of breast cancer. 98% died with median OS of all patients was 1.9 months (95% CI: 1.3-2.5 months). Conclusion: Despite improved treatments and targeted therapies, outcomes of LMC remain extremely poor. Positive CSF cytology was associated with lower OS in patients who had cytology assessed and specifically in patients with breast cancer. CSF cytology serves as an important indicator for prognosis and helps aid in developing individualized therapeutic strategies for patients with LMC.
KW - breast cancer
KW - cerebrospinal fluid
KW - Leptomeningeal carcinomatosis
KW - magnetic resonance imaging
KW - metastasis
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UR - http://www.scopus.com/inward/citedby.url?scp=85149474853&partnerID=8YFLogxK
U2 - 10.4274/ejbh.galenos.2021.2021-4-10
DO - 10.4274/ejbh.galenos.2021.2021-4-10
M3 - Article
C2 - 34651117
AN - SCOPUS:85149474853
SN - 2587-0831
VL - 17
SP - 371
EP - 377
JO - European Journal of Breast Health
JF - European Journal of Breast Health
IS - 4
ER -