Abstract
Leptomeningeal metastasis (LM) of high grade gliomas (HGG) can lead to devastating disease courses. Understanding of risk factors for LM is important to identify patients at risk. We reviewed patient records and magnetic resonance imaging (MRI) of all patients with a first diagnosis of HGG who underwent surgery in our institution between 2008 and 2012. To assess the influence of potential risk factors for LM and the impact of LM on survival multivariate statistics were performed. 239 patients with a diagnosis of HGG and at least 6 months of MRI and clinical follow-up were included. LM occurred in 27 (11%) patients and was symptomatic in 17 (65%). A strong correlation of surgical entry to the ventricle and LM was found (HR: 8.1). Ventricular entry was documented in 137 patients (57%) and LM ensued in 25 (18%) of these. Only two (2%) of 102 patients without ventricular entry developed LM. Median overall survival of patients after diagnosis of LM (239 days) was significantly shorter compared to patients without LM (626 days). LM is a frequent complication in the course of disease of HGG and is associated with poor survival. Surgical entry to the ventricle is a key risk factor for LM.
Highlights
While manifestation of malignant gliomas outside the central nervous system is extremely rare[1,2], leptomeningeal metastasis (LM) is a well-known but widely underestimated complication in the course of disease of these patients
Leptomeningeal metastasis was detected on magnetic resonance imaging (MRI) imaging of 27 (11%) of 239 consecutive patients with a first diagnosis of malignant glioma and surgery or biopsy between 2008 and 2012 at our institution
Patients with Leptomeningeal metastasis (LM) were more likely to be dead (96% vs. 68%) by the end of the observation period. 9 patients without LM on the last MRI were lost to Failure Event: Leptomeningeal Metastasis
Summary
While manifestation of malignant gliomas outside the central nervous system is extremely rare[1,2], leptomeningeal metastasis (LM) is a well-known but widely underestimated complication in the course of disease of these patients. Our knowledge about LM is based on small retrospective case series and case reports and its incidence and risk factors are incompletely understood. As multimodal glioblastoma treatment including surgery and chemoradiation extends overall survival from less than one year to up to 26 months, the likelihood of observing multifocal tumor dissemination might increase in the late course of the disease. Based on the largest patient cohort with long-term MRI follow-up investigated with respect to LM to date, the main objective of this study was to establish the incidence and risk factors of LM in patients with malignant gliomas. The impact of LM and ventricular entry on patient survival was analyzed
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