P16.02.B Leptomeningeal dissemination in gliomas in National Research Institute of Oncology in Gliwice experience

Abstract

Abstract Background The leptomeningeal dissemination (LMD) in the course of gliomas is rare. According to literature it can affect 4.7% of all patients with gliomas. LMD can be diagnosed at the initial presentation or at the time of recurrence. The standard therapy has not yet been determined. We aimed to present the clinical features and prognosis in retrospective analysis of patients with LMD in gliomas in National Institute of Oncology in Gliwice, Poland experience. Material and Methods Twenty patients with leptomeningeal dissemination in course of treatment of brain gliomas were identified. There were 16 men and 4 women. Median age of pts was 35,5 y (range 18-51). All tumours were supratentorial at diagnosis. There were 6 Diffuse Astocytomas, 3 oligodendrioglimas and 11 glioblatomas. In two patients LMD was found at initial diagnosis of GBM. The majority of patients (15 pts) presented clinical symptoms and in 5 asymptomatic pts LMD was diagnosed in MRI. The diagnosis was confirmed in craniospinal MRI. One patient was operated due to rapid clinical progression of spinal compression symptoms. All but one patient were offered palliative therapy. Radiotherapy was prescribed to 16 patients: in 7 pts for whole brain to C2, in 3 pts for craniospinal axis, in 7 for spinal canal and in 2 pts local therapy was performed. Mean dose of RT was 28,7 Gy/g (range 18-45 Gy/g). In 8 patients radiotherapy was combined with chemotherapy and chemotherapy as sole treatment was prescribed to 2 pts (Lomustin, EP). Results Mean time from initial diagnosis to LMD diagnosis was 46 mo (range 0,4-199 mo) for all patients and for non-GBM and GBM patients were 81,4 mo (16-199 mo) and 14,0 mo (0,4-27 mo) respectively. In 7 patients LMD was diagnosed concurrently with local relapse. In remaining mean time from local relapse to LMD was 4,6 mo (1,2-20,0 mo). Mean OS dated from time of LMD diagnosis for whole group was 5,9 mo (0,4-27 ), for non-GBM and GBM patients were 9,2 mo (3,6-27 mo) and 2,94 (0,4-12,7 mo) respectively. The palliative effect as improvement in clinical symptoms was achieved in 15 pts. Conclusion LMD in gliomas is rare but should be kept in mind while clinical symptoms in glioma patients occur. The prognosis of LMD is poor. Radiotherapy have palliative intent and it can affect the clinical symptoms and survival.