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Breast cancer leptomeningeal metastasis—the role of multimodality treatment

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Abstract

Aim

The aim of the study was to assess the efficacy of multimodality treatment of patients with Leptomeningeal metastasis (LM) and to establish which method of treatment has the greatest positive impact on survival.

Material and Methods

Clinical material included 67 consecutive breast cancer patients with LM treated at the Cancer Center in Warsaw between the years 2000 and 2005. Intrathecal chemotherapy was given to 57 pts (85%), intravenous chemotherapy to 41 pts (61%), whole brain radiotherapy to 33 pts (49%) and radiotherapy to the spinal leptomeninges to 10 (15%). For 27 pts (40%) three methods of treatment were used. Univariate and multivariate analyses were used to evaluate the impact of the particular method of treatment on survival and to assess the efficacy of combined modalities.

Results

Clinical response was achieved in 49 pts (76%). Median survival calculated from the diagnosis of LM was 16 weeks (range 1–402 weeks). Univariate analysis showed positive impact of systemic intravenous chemotherapy (P = 0,0009), intrathecal chemotherapy (P = 0,008) and whole brain radiotherapy (P = 0,004) on survival. The results of Cox multivariate analysis have shown systemic chemotherapy (P < 0.001) and intrathecal chemotherapy (P = 0.001) to be significant.

Conclusions

Intravenous chemotherapy and, independently, intrathecal chemotherapy improve survival in breast cancer patients with LM. Radiotherapy has a positive impact on the quality of life due to the alleviation of neurological symptoms. The role of radiotherapy in prolonging survival is questionable.

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References

  1. Jayson GC, Howell A (1996) Carcinomatous meningitis in solid tumours. Ann Oncol 7:773–786

    PubMed  CAS  Google Scholar 

  2. Steinfeld AD (1999) Radiation therapy. In: Roses DF (ed) Breast cancer, 2nd edn. Churchill Livingstone, Philadelphia

  3. Johnson KA, Kramer BS, Crane JM (1998) Management of central nervous system metastases in breast cancer. In: Bland KI, Copeland EM (eds) The breast. Comprehensive management of benign and malignant diseases, 2nd edn. WB Saunders Company, Philadelphia

    Google Scholar 

  4. De Angelis LM, Rogers LR, Foley KM (2000) Leptomeningeal metastasis. In: Harris JR, Lippman ME, Morrow M, Osborne CK (eds) Diseases of the breast, 2nd edn. Lippincott Wiliams &Wilkins, Philadelphia

    Google Scholar 

  5. Grossman SA, Krabak MJ (1999) Leptomeningeal carcinomatosis. Cancer Treat Rev 25:103–119

    Article  PubMed  CAS  Google Scholar 

  6. Chamberlain MC (2005) Neoplastic meningitis. J Clin Oncol 23:3605–3613

    Article  PubMed  Google Scholar 

  7. De Angelis L (2004) Leptomeningeal metastasis. In: Harris JR, Lippman ME, Morrow M, Osborne CK (eds) Diseases of the breast, 3rd edn. Lippincott Williams&Wilkins, Philadelphia

    Google Scholar 

  8. Wasserstrom WR, Glass JP, Posner JB (1982) Diagnosis and treatment of leptomeningeal metastasis from solid tumours: experience with 90 patients. Cancer 49:759–772

    Article  PubMed  CAS  Google Scholar 

  9. Jayson GC, Howell A, Harris M et al (1994) Carcinomatous meningitis in breast cancer: an agressive disease variant. Cancer 74:3135–3141

    Article  PubMed  CAS  Google Scholar 

  10. Fisazi K, Asselain B, Vincent- Salomon A et al (1996) Meningeal carcinomatosis in patients with breast carcinoma. Cancer 77:1315–1323

    Article  Google Scholar 

  11. Giannone L, Greco FA, Hainsworth JD (1986) Combination intraventricular chemotherapy for meningeal neoplasia. J Clin Oncol 4:68–73

    PubMed  CAS  Google Scholar 

  12. Yap H, Yap B, Rasmussen S et al (1982) Treatment for meningeal carcinomatosis on breast cancer. Cancer 49:219–222

    Article  Google Scholar 

  13. Boogerd W, Bent MJ, Koehler PJ et al (2004) The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomized study. Eur J Cancer 40:2726–2733

    Article  PubMed  CAS  Google Scholar 

  14. Hildebrand J (1998) Prophylaxis and treatment of leptomeningeal carcinomatosis in solid tumors of adulthood. J Neurooncol 38:193–198

    Article  PubMed  CAS  Google Scholar 

  15. Boogerd W, Hart AAM, van der Sande JJ et al (1991) Meningeal carcinomatosis in breast cancer. Prognostic factors and influence of treatment. Cancer 67:1685–1695

    Article  PubMed  CAS  Google Scholar 

  16. Grossman SA, Finkelstein DM, Ruckdeschel DL et al (1993) Randomised prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. J Clin Oncol 11:561–569

    PubMed  CAS  Google Scholar 

  17. Ongerboer de Visser BW, Somers R, Nooyen WH et al (1983) Intraventricular methotrexate therapy of leptomeningeal metastasis from breast cancer. Neurology 33:1565–1572

    Google Scholar 

  18. Hitchins RN, Bell DR, Woods RL et al (1987) A prospective randomized trial of single agent versus combination chemotherapy in meningeal carcinomatosis. J Clin Oncol 5:1655–1662

    PubMed  CAS  Google Scholar 

  19. Siegal T, Lossos A, Pfeffer MR (1994) Leptomeningeal metastases: analysis of 31 patients with sustained off-therapy response following combined-modality therapy. Neurology 4:1463–1469

    Google Scholar 

  20. Bokstein F, Lossos A, Siegal T (1998) Leptomeningeal metastases from solid tumors: a comparison of two prospective series treated with and without intra-cerebrospinal fluid chemotherapy. Cancer 82:1756–1763

    Article  PubMed  CAS  Google Scholar 

  21. Gilbert MR, Harding BL, Grossman SA (1989) Methotrexate neurotoxicity: in vitro studies using cerebellar explants from rats. Cancer Res 49:2502–2505

    PubMed  CAS  Google Scholar 

  22. Boogerd , van der Sande JJ, Moffie D (1988) Acute fever and delayed leucoencephalophathy following low dose intraventricular methotrexate. J Neurol Neurosurg Psych 51:1277–1283

    Article  CAS  Google Scholar 

  23. Mena H, Garcia JH, Velandia F (1981) Central and peripheral myelopathy associated with systemic neoplastic and chemotherapy. Cancer 48:1724–1737

    Article  PubMed  CAS  Google Scholar 

  24. Blaney SM, Balis FM, Poplack DG (1991) Pharmacologic approaches to the treatment of meningeal malignancy. Oncology 5:107–116

    PubMed  CAS  Google Scholar 

  25. Ushio Y, Posner JB, Shapiro WR et al (1977) Chemotherapy of experimental meningeal carcinomathosis. Cancer Res 37:1232–1237

    PubMed  CAS  Google Scholar 

  26. Grant R, Naylor B, Greenberg HS et al (1994) Clinical outcome in aggresively treated meningeal carcinomathosis. Arch Neurol 51:457–461

    PubMed  CAS  Google Scholar 

  27. 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

    PubMed  CAS  Google Scholar 

  28. Mencel PJ, DeAngelis LM, Motzer RJ (1994) Hormonal ablation is effective therapy for carcinomatous meningitis from prostatic carcinoma. Cancer 73:1892–1894

    Article  PubMed  CAS  Google Scholar 

  29. Van der Graaf WT, Haaxma-Reiche H, Burghouts JT et al (1993) Teniposide for meningeal carcinomatosis of small-cell lung cancer. Lung Cancer 3:247–249

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Breast Cancer, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Roentgen 5 str., 02-781, Warsaw, Poland

    Halina Rudnicka & Anna Niwińska

  2. Department of Biostatistics, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

    Magdalena Murawska

Authors
  1. Halina Rudnicka
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  2. Anna Niwińska
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  3. Magdalena Murawska
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Correspondence to Anna Niwińska.

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Rudnicka, H., Niwińska, A. & Murawska, M. Breast cancer leptomeningeal metastasis—the role of multimodality treatment. J Neurooncol 84, 57–62 (2007). https://doi.org/10.1007/s11060-007-9340-4

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  • DOI: https://doi.org/10.1007/s11060-007-9340-4

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