Impact of Multimodality Approach for Patients with Leptomeningeal Metastases from Solid Tumor

Abstract

Purpose: To identify the prognostic factors and define the role of multimodality approach for patients with leptomeningeal metastases (LM) from solid tumor. Materials and Methods: Medical records of 80 patients diagnosed with LM from solid tumor from January 1, 2004 to May 31, 2011 were retrospectively reviewed. Most frequent site of origin was lung (59%) followed by breast (25%) and stomach (16%). Median age was 54 years. Forty-nine female and 31 male were included. Two thirds of patients were ECOG class 1 or 2. Most patients were treated with intrathecal chemotherapy (IT-CTx) and whole brain RT (WBRT), 90% and 67.5%, respectively. Systemic chemotherapy (SysCTx) was offered to 33.8%. Patients treated with single, dual, and triple modality were 32.5%, 43.8%, and 23.8%, respectively. Results: Median survival was 2.7 months and 1 year survival rate was 11.3%. Multivariate analysis showed that negative CSF cytology (P < 0.001), fewer regimen of CTx prior to LM (P = 0.026), WBRT (P = 0.01), Sys-CTx (P < 0.001), and combined modality treatment (P < 0.001) had statistically significance on survival. NSCLC subgroup analysis showed that negative CSF cytology, target agent (EGFR-TKI) and CMT had significant impact on survival. Median survival of patients with treatment including target agent was 10.1 months. Conclusions: Unlike previous reports, no factors among the characteristics of patients and symptoms at the time of presenting LM affected survival, and survival of patients with NSCLC was comparable to breast. Furthermore, CMT significantly improved survival outcome for all patients and use of target agent for NSCLC patients. Role of radiotherapy in conjuction with target agent needs to be validated in future studies.