Journal of Neuro-Oncology

, Volume 104, Issue 2, pp 565–572 | Cite as

Meningeal carcinomatosis in breast cancer: prognostic factors and outcome

  • Carla Rameri Alexandre Silva de Azevedo
  • Marcelo Rocha Sousa Cruz
  • Ludmilla Thomé Domingos Chinen
  • Stela Verzinhasse Peres
  • Marcos Aurélio Peterlevitz
  • Artur Eugênio de Azevedo Pereira
  • Marcello Ferretti Fanelli
  • Daniel Luiz Gimenes
Clinical Study – Patient Study

Abstract

Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27–76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03–90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients.

Keywords

Leptomeninges Meningeal carcinomatosis Prognostic factor Central nervous system Breast cancer 

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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Carla Rameri Alexandre Silva de Azevedo
    • 1
  • Marcelo Rocha Sousa Cruz
    • 1
  • Ludmilla Thomé Domingos Chinen
    • 1
  • Stela Verzinhasse Peres
    • 2
  • Marcos Aurélio Peterlevitz
    • 1
  • Artur Eugênio de Azevedo Pereira
    • 3
  • Marcello Ferretti Fanelli
    • 1
  • Daniel Luiz Gimenes
    • 1
  1. 1.Department of Medical OncologyHospital A. C. CamargoLiberdade, Sao PauloBrazil
  2. 2.Department of Epidemiology, Faculdade de Saúde PúblicaUniversidade de São PauloSao PauloBrazil
  3. 3.Instituto do Coração, Faculdade de Medicina Universidade de São PauloSao PauloBrazil

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