Breast cancer leptomeningeal metastasis: propensity of breast cancer subtypes for leptomeninges and the analysis of factors influencing survival

Anna Niwińska,Halina Rudnicka,Magdalena Murawska

doi:10.1007/s12032-012-0408-4

Abstract

The aim of the study was to define biological subtypes of breast cancer that have the propensity to metastasize to the leptomeninges and to assess factors influencing survival from detection of leptomeningeal metastatis (LM). One hundred and eighteen consecutive breast cancer patients with LM were treated in one institution, between the years 1999 and 2009; 40.5 % of patients had triple-negative subtype, 37.5 % had luminal A subtype and 22 % had HER2-positive subtypes (luminal B and HER2). Of patients with LM, 35 % had lobular cancer. Median survival from the detection of LM was 18 weeks, and 1-year survival was 16 %. Cox multivariate analysis revealed that performance status and systemic treatment statistically significantly influenced survival of patients with LM. Triple-negative biological subtype and lobular histological type of breast cancer had the propensity to metastasize to the leptomeninges. Performance status and systemic treatment ordered after detection of LM statistically significantly influenced survival.

Highlights

Leptomeningeal metastasis (LM) is a deleterious complication of breast cancer leading to death within less than 4–6 months following the diagnosis [1,2,3,4]
In 114 out of 118 patients, leptomeningeal metastatis (LM) was diagnosed based on the demonstration of cancer cells in cerebrospinal fluid (CSF)
The initial magnetic resonance imaging (MRI) revealed diffused enhancement of leptomeninges in 114 patients (97 %), tumour nodules in 14 patients (12 %), secondary hydrocephalus in 13 patients (11 %) and parenchymal brain metastases which coexisted with LM in 45 patients (38 %)

Summary

Introduction

Leptomeningeal metastasis (LM) is a deleterious complication of breast cancer leading to death within less than 4–6 months following the diagnosis [1,2,3,4]. It touches between 2 and 5 % of patients with metastatic breast cancer, usually later in the course of their disease. Due to the fact that LM is becoming an increasingly common complication of breast cancer [2, 4] it is important to know which histological and biological type of newly diagnosed breast cancer has the propensity to metastasize to the leptomeninges and what type of treatment of LM is mostly effective

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Conclusion