AOS10 Prognostic factors for patients with leptomeningeal metastases from solid tumours

Abstract

Background This study was designed to identify the factors affecting survival in patients with leptomeningeal metastases from solid tumours and define the role of various treatments. Methods Medical records of 82 patients who were diagnosed with leptomeningeal metastases from solid tumours from January 1, 2004, to May 31, 2011, were retrospectively reviewed. The most frequent site of origin was the lung (57.1%) followed by breast (25%) and stomach (15.5%). Median age of patients was 54 years (range 27–78). Two-thirds of patients had an Eastern Cooperative Oncology Group (ECOG) performance status class of 1 or 2. Patients were treated with various combinations of intrathecal chemotherapy (85.7%), whole brain radiotherapy (65.5%), systemic chemotherapy (31%), and spinal radiotherapy (22.7%). 29.3%, 42.7%, and 23.2% of patients were treated with single, dual, and triple modalities, respectively. Findings Median survival was 2.6 months and the 1-year survival rate was 9.7%. Univariate analysis showed significantly different survival rates according to age, site of origin, cerebrospinal fluid (CSF) leukocytosis, CSF cytology, intrathecal chemotherapy, systemic chemotherapy, and combined modality. Furthermore, there was a trend towards improved survival with an increase in the number of cycles of chemotherapy and whole brain radiotherapy. Multivariate analysis showed that positive cytology in CSF (positive [6.3 months] versus negative [2.2 months], p = 0.003), intrathecal chemotherapy (done [2.7 months] versus not done [2.1 months], p = 0.009), systemic chemotherapy (done [7.6 months] versus not done [1.9 months], p = 0.029), and combined modality treatment (single [1.2 months] versus dual [3.5 months] versus triple [8.3 months], p = 0.002) had statistically significant effects on survival. Interpretation Unlike previous reports, no factors among the characteristics of patients and symptoms at the time of diagnosis of leptomeningeal metastases affected survival, including performance status, and survival in patients with primary non-small cell lung cancer (NSCLC) tumours was comparable with that in patients with primary breast tumours. Furthermore, survival improvement was significant with combined modality treatment over single modality treatment. Thus, multimodality treatment should be sought for patients with feasible performance in tolerating treatment and those with not only breast primary but also NSCLC primary tumours. The authors declared no conflicts of interest.