Skip to main content

Advertisement

SpringerLink
Log in

Meningeal carcinomatosis in breast cancer: prognostic factors and outcome

  • Clinical Study – Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Paik S, Shak S, Tang G et al (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351:2817–2826

    Article  PubMed  CAS  Google Scholar 

  2. Goldhirsch A, Ingle JN, Gelber RD et al (2009) Thresholds for therapies: highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2009. Ann Oncol 20:1319–1329

    Article  PubMed  CAS  Google Scholar 

  3. Kennecke H, Yerushalmi R, Woods R et al (2010) Metastatic behavior of breast cancer subtypes. J Clin Oncol 28:3271–3277

    Article  PubMed  Google Scholar 

  4. Chamberlain MC (2005) Neoplasic meningitis. J Clin Oncol 23:3605–3613

    Article  PubMed  Google Scholar 

  5. Chamberlain MC, Kormanik PRN (1997) Carcinomatous meningitis secondary to breast cancer: predictors of response to combined modality therapy. J Neurooncol 35:55–64

    Article  PubMed  CAS  Google Scholar 

  6. Rudnicka H, Niwińska A, Murawska M (2007) Breast cancer leptomeningeal metastasis—the role of multimodality treatment. J Neurooncol 84:57–62

    Article  PubMed  Google Scholar 

  7. Andre F, Slimane K, Bachelot T et al (2004) Breast cancer with synchronous metastasis: trends in survival during a 14-year period. J Clin Oncol 22:3302–3308

    Article  PubMed  Google Scholar 

  8. Weil RJ, Palmieri DC, Bronder JL, Stark AM, Steeg PS (2005) Breast cancer metastasis to the central nervous system. Am J Pathol 167:913–920

    Article  PubMed  CAS  Google Scholar 

  9. Boogerd W, Hart AAM, Sande JJV, Engelsman E (1991) Meningeal carcinomatosis in breast cancer. Cancer 15:1685–1695

    Article  Google Scholar 

  10. Bruna J, Gonzalez L, Miro J et al (2009) Leptomeningeal carcinomatosis. Prognostic implications of clinical and cerebrospinal fluid features. Cancer 115:381–389

    Article  PubMed  Google Scholar 

  11. Waki F, Ando M, Takashima A et al (2009) Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors. J Neurooncol 93:205–212

    Article  PubMed  Google Scholar 

  12. Chamberlain MC, Johnston SK, Glantz MJ (2009) Neoplastic meningitis—related prognostic significance of the karnofsky performance status. Arch Neurol 66:74–78

    Article  PubMed  Google Scholar 

  13. Chamberlain MC, Kormanik PA (1996) Prognostic significance of 111 indium-DTPA CSF flow studies in leptomeningeal metastases. Neurology 46:1674–1677

    PubMed  CAS  Google Scholar 

  14. Chamberlain MC, Johnston SK (2009) Neoplastic meningitis. Survival as a function of cerebrospinal fluid cytology. Cancer. doi:10.1002/cncr.24210

    Google Scholar 

  15. Sze G, Soletsky S, Bronen R, Krol G (1989) MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. Am J Roentgenol 153:1039–1049

    CAS  Google Scholar 

  16. Gomori JM, Heching N, Siegal Tali (1998) Leptomeningeal metastases: evaluation by gadolinium enhanced spinal magnetic resonance imaging. J Neurooncol 36:55–60

    Article  PubMed  CAS  Google Scholar 

  17. Bloom HJ, Richardson WW (1957) Histological grading and prognosis in breast cancer: a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer 11:359–377

    Article  PubMed  CAS  Google Scholar 

  18. Rakha EA, El-Sayed ME, Lee AHS et al (2008) Prognostic significance of Nottingham histologic grade in invasive breast carcinoma. J Clin Oncol 26:3153–3158

    Article  PubMed  Google Scholar 

  19. Rosen PP (1997) Rosen’s breast pathology. Lippincott-Raven, Philadelphia, pp 275–293

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  21. Gauthier H, Guilhaume MN, Bidard FC et al (2010) Survival of breast cancer patients with meningeal carcinomatosis. Ann Oncol. doi:10.1093/annonc/mdq232

    Google Scholar 

  22. 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

    Article  PubMed  CAS  Google Scholar 

  23. Slimane K, Andre F, Delaloge S et al (2004) Risk factors for brain relapse in patients with metastatic breast cancer. Ann Oncol 15:1640–1644

    Article  PubMed  CAS  Google Scholar 

  24. Hines SL, Vallow LA, Tan WW et al (2008) Clinical outcomes after a diagnosis of brain metastases in patients with estrogen- and/or human epidermal growth factor receptor 2-positive versus triple-negative breast cancer. Ann Oncol 19:1561–1565

    Article  PubMed  CAS  Google Scholar 

  25. Dawood S, Broglio K, Esteva FJ et al (2010) Survival of breast cancer patients with meningeal carcinomatosis. Ann Oncol 21:2183–2187

    Article  Google Scholar 

  26. Rakha EA, El-Sayed M, Green AR et al (2007) Prognostic markers in triple-negative breast cancer. Cancer 109:25–32

    Article  PubMed  CAS  Google Scholar 

  27. Boogerd W, van den 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 

  28. Gaviani P, Silvani A, Corsini E et al (2009) Neoplastic meningitis from breast carcinoma with complete response to liposomal cytarabine: case report. Neurol Sci 30:251–254

    Article  PubMed  Google Scholar 

  29. 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 tumours. Clin Cancer Res 5:3394–3402

    PubMed  CAS  Google Scholar 

  30. 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

    PubMed  CAS  Google Scholar 

  31. Stemmler HJ, Schmitt M, Harbeck N et al (2006) Application of intrathecal trastuzumab (Herceptin™) for treatment of meningeal carcinomatosis in Her2-overexpression metastatic breast cancer. Oncol Reports 15:1373–1377

    CAS  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Hospital A. C. Camargo, Rua Prof. Antônio Prudente, 211, CEP 01509-900, Liberdade, Sao Paulo, Brazil

    Carla Rameri Alexandre Silva de Azevedo, Marcelo Rocha Sousa Cruz, Ludmilla Thomé Domingos Chinen, Marcos Aurélio Peterlevitz, Marcello Ferretti Fanelli & Daniel Luiz Gimenes

  2. Department of Epidemiology, Faculdade de Saúde Pública, Universidade de São Paulo, Sao Paulo, Brazil

    Stela Verzinhasse Peres

  3. Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil

    Artur Eugênio de Azevedo Pereira

Authors
  1. Carla Rameri Alexandre Silva de Azevedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcelo Rocha Sousa Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ludmilla Thomé Domingos Chinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stela Verzinhasse Peres
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcos Aurélio Peterlevitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Artur Eugênio de Azevedo Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcello Ferretti Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Luiz Gimenes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carla Rameri Alexandre Silva de Azevedo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Azevedo, C.R.A.S., Cruz, M.R.S., Chinen, L.T.D. et al. Meningeal carcinomatosis in breast cancer: prognostic factors and outcome. J Neurooncol 104, 565–572 (2011). https://doi.org/10.1007/s11060-010-0524-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-010-0524-y

Keywords

Search

Navigation