Abstract
Background
The purpose of the present study was to investigate outcome after whole brain radiotherapy (WBRT) alone as a palliative treatment without concomitant chemotherapy for intracranial leptomeningeal carcinomatosis (LMC).
Patients and methods
Overall survival and treatment response were retrospectively analyzed in 27 consecutive patients with LMC from breast and lung cancer. All patients had evidence of intracranial manifestations of LMC. Seven potential prognostic factors were evaluated.
Results
Median overall survival (OS) for the entire group was 8.1 weeks. OS rates after 6 and 12 months were 26% and 15%, respectively. Improvement of neurological deficits was observed in 3 patients. In 3 of 4 patients with follow-up MRI studies, a decreased size of contrast-enhanced lesions was observed. Prognostic factors for improved OS on univariate analysis were absence of cranial nerve dysfunction, Karnofsky Performance Score (KPS) > 60%, and time interval > 35 months between the initial diagnosis of malignant disease and development of LMC. On multivariate analysis, absence of cranial nerve dysfunction remained the only significant prognosticator for OS (median 3.7 vs. 19.4 weeks, p < 0.001).
Conclusion
WBRT alone is an effective palliative treatment for patients unfit/unsuitable for chemotherapy and low performance status suffering from intracranial LMC. However, prognostic factors should be considered in order to identify patients who are likely to benefit from WBRT.
Zusammenfassung
Hintergrund
Die vorliegende Studie verfolgt das Ziel, den Stellenwert der alleinigen Ganzhirnbestrahlung (WBRT) ohne simultane Chemotherapie als palliative Therapiemaßnahme der intrakraniellen Leptomeningeosis carcinomatosa (LMC) zu evaluieren.
Patienten und Methodik
27 konsekutive Patienten mit einer LMC solider Tumoren (Brustkrebs, Bronchialkarzinom), die mit alleiniger WBRT behandelt wurden, sind retrospektiv hinsichtlich Gesamtüberleben und Therapieansprechen untersucht worden. Alle Patienten wiesen einen intrakraniellen Befall der Hirnhäute auf. Darüber hinaus wurden 7 potentielle prognostische Faktoren analysiert.
Ergebnisse
Das mediane Gesamtüberleben lag bei 8,1 Wochen, das Gesamtüberleben nach 6 und 12 Monaten bei 26% bzw. 15%. Eine Besserung neurologischer Symptome ergab sich bei 3 Patienten. Bei 3 von 4 Patienten, für die eine MRT-Verlaufsbildgebung vorlag, zeigte sich eine deutliche Größenregredienz kontrastmittelaufnehmender Befunde. Prognostische Faktoren für ein verbessertes Gesamtüberleben in der univariaten Analyse waren das Fehlen von Hirnnervenausfällen, ein KPS > 60% und ein Zeitintervall > 35 Monate zwischen Primärdiagnose und Entwicklung der LMC. In der multivariaten Analyse verblieb als Prädiktor für ein besseres Gesamtüberleben das Fehlen von Hirnnervenausfällen. Das mediane Gesamtüberleben lag bei 3,7 vs. 19,4 Wochen (p < 0,001).
Schlussfolgerung
Die alleinige WBRT ist eine effektive Behandlungsoption für Patienten mit intrakranieller LMC, die nicht geeignet für eine Chemotherapie sind und einen eingeschränkten Allgemeinzustand vorweisen. Prognosefaktoren sollten in der Therapieentscheidung berücksichtigt werden, um Patienten, die wahrscheinlich von der WBRT profitieren, zu identifizieren.
References
Blaney SM, Poplack DG (2000) Neoplastic meningitis: diagnosis and treatment considerations. Med Oncol 17:151–162
Boogerd W, Hart AA, Sande JJ van der, Engelsman E (1991) Meningeal carcinomatosis in breast cancer. Prognostic factors and influence of treatment. Cancer 67:1685–1695
Boogerd W, Bent MJ van den, Koehler PJ et al (2004) The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study. Eur J Cancer 40:2726–2733
Chamberlain MC (2008) Neoplastic meningitis. Oncologist 13:967–977
Chamberlain MC (2005) Neoplastic meningitis. J Clin Oncol 23:3605–3613
Clamon G, Doebbeling B (1987) Meningeal carcinomatosis from breast cancer: spinal cord vs. brain involvement. Breast Cancer Res Treat 9:213–217
Feyer P, Sautter-Bihl ML, Budach W et al (2010) DEGRO Practical Guidelines for palliative radiotherapy of breast cancer patients: brain metastases and leptomeningeal carcinomatosis. Strahlenther Onkol 186:63–69
Fizazi K, Asselain B, Vincent-Salomon A et al (1996) Meningeal carcinomatosis in patients with breast carcinoma. Clinical features, prognostic factors, and results of a high-dose intrathecal methotrexate regimen. Cancer 77:1315–1323
Fokas E, Henzel M, Engenhart-Cabillic R (2010) A comparison of radiotherapy with radiotherapy plus surgery for brain metastases from urinary bladder cancer: analysis of 62 patients. Strahlenther Onkol 186:565–571
Glantz MJ, Cole BF, Recht L et al (1998) High-dose intravenous methotrexate for patients with nonleukemic leptomeningeal cancer: is intrathecal chemotherapy necessary? J Clin Oncol 16:1561–1567
Glantz MJ, Jaeckle KA, Chamberlain MC et al (1999) A randomized controlled trial comparing intrathecal sustained-release cytarabine (DepoCyt) to intrathecal methotrexate in patients with neoplastic meningitis from solid tumors. Clin Cancer Res 5:3394–3402
Grossman SA, Finkelstein DM, Ruckdeschel JC et al (1993) Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group. J Clin Oncol 11:561–569
Grossman SA, Krabak MJ (1999) Leptomeningeal carcinomatosis. Cancer Treat Rev 25:103–119
Heisterkamp C, Haatanen T, Schild SE, Rades D (2010) Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer. Strahlenther Onkol 186:70–75
Hermann B, Hultenschmidt B, Sautter-Bihl ML (2001) Radiotherapy of the neuroaxis for palliative treatment of leptomeningeal carcinomatosis. Strahlenther Onkol 177:195–199
Herrlinger U, Forschler H, Kuker W et al (2004) Leptomeningeal metastasis: survival and prognostic factors in 155 patients. J Neurol Sci 223:167–178
Jayson GC, Howell A, Harris M et al (1994) Carcinomatous meningitis in patients with breast cancer. An aggressive disease variant. Cancer 74:3135–3141
Oechsle K, Lange-Brock V, Kruell A et al (2010) Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis. J Cancer Res Clin Oncol 136:1729–1735
Pentheroudakis G, Pavlidis N (2005) Management of leptomeningeal malignancy. Expert Opin Pharmacother 6:1115–1125
Sas-Korczynska B, Korzeniowski S, Wojcik E (2010) Comparison of the effectiveness of “late” and “early” prophylactic cranial irradiation in patients with limited-stage small cell lung cancer. Strahlenther Onkol 186:315–319
Sause WT, Crowley J, Eyre HJ et al (1988) Whole brain irradiation and intrathecal methotrexate in the treatment of solid tumor leptomeningeal metastases-a Southwest Oncology Group study. J Neurooncol 6:107–112
Taillibert S, Hildebrand J (2006) Treatment of central nervous system metastases: parenchymal, epidural, and leptomeningeal. Curr Opin Oncol 18:637–643
Wasserstrom WR, Glass JP, Posner JB (1982) Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49:759–772
Watanabe M, Tanaka R, Takeda N (1993) Correlation of MRI and clinical features in meningeal carcinomatosis. Neuroradiology 35:512–515
Weller M (2005) Leitlinie zur Diagnostik und Therapie der Meningeosis neoplastica der Neuro-Onkologischen Arbeitsgemeinschaft (NOA) und der Arbeitsgemeinschaft Internistische Onkologie (AIO) in der Deutschen Krebsgesellschaft (11/2005, http://www.neuroonkologie.de/fileadmin/neuroonkologie/pdf/leitmeni.pdf). Accessed 14 December 2011
Conflict of interest
The corresponding author states that there are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
The first two authors contributed equally to the study.
Rights and permissions
About this article
Cite this article
Gani, C., Müller, A., Eckert, F. et al. Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumors. Strahlenther Onkol 188, 148–153 (2012). https://doi.org/10.1007/s00066-011-0025-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00066-011-0025-8
Keywords
- Leptomeningeal carcinomatosis
- Whole brain radiotherapy
- Solid tumors
- Cumulative survival rate
- Prognostic factors