Abstract
Background
Meningeal carcinomatosis (MC) is an uncommon but aggressive complication of advanced breast cancer with a recently increasing incidence. Although the prognosis is extremely poor for MC patients, early diagnosis and appropriate treatment are important. Subjects and Methods: We reviewed 8 cases of MC from breast cancer at Kyoto University Hospital from 1990 to 1999. The median age was 51.5 years. All patients had widespread systemic metastases when diagnosed with MC. clinical symptoms were categorized into 3 groups: cranial nerve symptoms, spinal nerve symptoms, and other symptoms. Imaging studies were positive for MC in only 4 patients. Initial CSF cytology studies were positive in 4 patients, and repeated CSF cytology yielded positive results in the remaining 4 patients. Thus the median interval between the onset of any clinical symptom of MC and the initiation of treatment was 22.5 days (range 7 to 120 days ). All patients received whole brain radiotherapy (WBRT). Four patients were given intrathecal chemotherapy and/or intrathecal immunotherapy in addition to WBRT
Results
Improvement of cranial nerve symptoms, spinal nerve symptoms, and other symptoms were observed in 3/5, 1/3, and 5/7 patients, respectively. Patients with cranial nerve symptoms who started WBRT within 29 days of the onset of the symptoms showed at least partial recovery whereas patients who started WBRT later showed no recovery. The median survival was 123 days (53 to 310 days). MC was the direct cause of death in 1 of 8 patients
Conclusion
When MC is clinically suspected, neither a negative imaging study nor a single negative CSF cytology can rule out MC. Prompt initiation of WBRT with or without intrathecal chemotherapy may be important for recovery from cranial nerve symptoms
Similar content being viewed by others
References
Boogerd W, Hart AA, van der Sande JJ,et al: Meningeal carcinomatosis in breast cancer: Prognostic factors and influence of treatment.Cancer 67:1685–1695, 1991.
Siegal T, Lossos A and Pfeffer MR: Leptomeningeal metastases: analysis of 31 patients with sustained off-therapy response following combined-modality therapy [see comments].Neurology 44:1463–1469, 1994.
Moots PL, Harrison MB and Vandenberg SR: Prolonged survival in carcinomatous meningitis associated with breast cancer.South Med J 88:357–362, 1995.
Kan N, Kodama H, Hori T,et al: Intrapleural adaptive immunotherapy for breast cancer patients with cyto-logically-confirmed malignant pleural effusions: An analysis of 67 patients in Kyoto and Shiga Prefecture, Japan. BreastCancer Res Treat 27:203–210, 1993.
Jayson GC, Howell A, Harris M,et al: Carcinomatous meningitis in patients with breast cancer. An aggressive disease variant.Cancer 74:3135–3141, 1994.
Fizazi K, Asselain B, Vincent-Salomon A,et al: Meningeal carcinomatosis in patients with breast carcinoma. Clinical features, prognostic factors, and results of a high-dose intrathecal methotrexate regimen.Cancer 77:1315–1323, 1996.
Oschmann P, Kaps M, Volker J,et al: Meningeal carcinomatosis: CSF cytology, immunocytochemistry and biochemical tumor markers.Acta Neurol Scand 89:395–399, 1994.
Jorda M, Ganjei-Azar Pand Nadji M: Cytologic characteristics of meningeal carcinomatosis: Increased diagnostic accuracy using carcinoembryonic antigen and epithelial membrane antigen immunocytochemistry.Arch Neurol 55:181–184, 1998.
Friedberg MH, Glantz MJ, Hempner MS,et al: Specific matrix metalloproteinase profiles in the cerebrospinal fluid correlated with the presence of malignant astrocytomas, brain metastases, and carcinomatous meningitis.Cancer 82:923–930, 1998.
Wasserstrom WR, Glass JP and Posner JB: Diagnosis and treatment of leptomeningeal metastases from solid tumors: Experience with 90 patients.Cancer 49:759–772, 1982.
Grant R, Naylor B, Greenberg HS,et al: Clinical outcome in aggressively treated meningeal carcinomatosis.Arch Neurol 51:457–461, 1994.
Nakagawa H, Fujita T, Kubo S,et al: Ventriculolumbar perfusion chemotherapy with methotrexate and cytosine arabinoside for meningeal carcinomatosis: A pilot study in 13 patients.Surg Neurol 45:256–264, 1996.
Author information
Authors and Affiliations
About this article
Cite this article
Yu, H., Mitsumori, M., Nagata, Y. et al. Meningeal carcinomatosis in patients with Breast Cancer: Report of 8 patients. Breast Cancer 8, 74–78 (2001). https://doi.org/10.1007/BF02967482
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02967482