Abstract
Aim: The aim of this study was to report the clinical features of patients with LM originating from gastric cancer and the outcomes of intrathecal (IT) chemotherapy with methotrexate (MTX) in these patients.
 Method: This study analyzed retrospectively the medical records of 10 patients with gastric cancer, who were diagnosed with LM and received IT chemotherapy with MTX at Kosin University Gospel Hospital between January 2007 and December 2017.
 Results: Of 10 patients, half was male and the median age at LM diagnosis was 49 years (rang, 33–72). All patients but one had a poor performance status. Seven patients had poorly differentiated or signet ring cell adenocarcinomas, and six had Borrmann type III or IV gastric cancer. The median time from diagnosis of gastric cancer to the development of LM was 22.6 months (range, 4.93–103.7). LM was detected by brain magnetic resonance imaging in 6 patients, and was established in cerebrospinal fluid (CSF) analysis in all 10 patients. IT MTX for LM was administrated in all 10 patients, and the median 6 cycles of IT MTX was performed (range, 1–35). Three patients achieved negative conversion of malignant cytology in CSF. Systemic chemotherapy was performed in 5 patients. The median survival time from LM diagnosis was 2.1 months (95% confidence interval [CI], 1.5–2.7). Two patients survived about 12 months after LM diagnosis.
 Conclusion: Although the prognosis of LM in gastric cancer patients was poor, the administration of IT MTX might have clinical benefit in some selected patients.
Highlights
Introduction neuroimaging modalities for detection ofLM [1][2].Leptomeningeal metastasis (LM), known as leptomeningeal carcinomatosis or carcinomatous meningitis when malignant cells originated from a solid tumor, refers to the multifocal seeding of leptomeninges by cancer [1]
LM was confirmed in patients who presented with symptoms of signs suggesting LM, by either (1) radiologic evidence of LM on contrast-enhanced magnetic resonance imaging (MRI) of the brain, or (2) abnormal findings of cerebrospinal fluid (CSF) analysis suggesting LM
Nearly every advanced solid tumor has been reported to metastasize to leptomeninges, LM is frequently detected in lung cancer, breast cancer, and melanoma [3][6]
Summary
Leptomeningeal metastasis (LM), known as leptomeningeal carcinomatosis or carcinomatous meningitis when malignant cells originated from a solid tumor, refers to the multifocal seeding of leptomeninges by cancer [1]. LM is detected clinically in approximately 5–8% of patients with solid tumor, and mostly presented at the late stage of disease [2][3]. The incidence of LM is increased due to prolonged survival time of patients with advanced solid tumors and improvement in. There is no standard treatment for LM. Treatment options are radiotherapy of the affected area, intrathecal (IT) chemotherapy, and systemic chemotherapy for primary tumors [1]. IT chemotherapy is a currently main treatment, because IT administration of drugs bypasses the blood-brain barrier (BBB) and results in higher drug concentration. Methotrexate (MTX), cytarabine, and, less often, thiothepa are available drugs for IT chemotherapy, and MTX is the most commonly used and studies agent [2]
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