Optimal treatment of leptomeningeal spread in glioblastoma: analysis of risk factors and outcome.

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Glioblastoma (GBM) is the most common and malignant brain tumor in adults. Despite therapeutic advances, almost all patients eventually experience tumor recurrence. Leptomeningeal spread (LMS) is not a rare condition of recurrence. However, the standard management protocol of LMS has not been established. The aim of this study is to report the risk of (LMS) and the prognosis between treatment modalities in GBM patients. A retrospective review was conducted of 321 patients who were diagnosed with GBM between January 2006 and December 2010. In 75 patients, LMS of tumor was detected by magnetic resonance image and/or cerebrospinal fluid cytology. Twelve patients underwent intrathecal methotrexate (IT-MTX) chemotherapy. Twenty-two patients underwent other salvage treatments. Forty-one patients underwent conservative management. We analyzed the possible clinical factors for LMS. Further, we examined overall survival and survival after diagnosis of LMS for several treatment modalities. In patients without LMS, median overall survival was 479 days, whereas that in patients with LMS it was 401 days. Younger age and larger initial tumor size were related to more frequent LMS incidence. Proximity between tumor margin and ventricle did not affect LMS. However, median duration from initial diagnosis to LMS was significantly different according to the distance to the ventricle. IT-MTX group's overall survival was 583 days, which is statistically no longer than that of the other treatment group and the conservative management group. However, an additional survival benefit may exist compared to the conservative treatment. The median survival of the IT-MTX group was 181 days compared with 91 days for the conservative management group. Treatment of LMS is mainly palliative. IT-MTX is generally the first-line treatment modality of LMS. Prediction and prevention of LMS is crucial because its treatment has been limited. Further approaches to improve the therapeutic effect should be established.