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. 2008;3(2):118-123.
doi: 10.1159/000121688. Epub 2008 Apr 15.

Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Anne Constanze Regierer  1 , Andrea Stroux, Dagmar Kühnhardt, Annette Dieing, Silvia Lehenbauer-Dehm, Bernd Flath, Kurt Possinger, Jan Eucker
Affiliations

Contrast-Enhancing Meningeal Lesions Are Associated with Longer Survival in Breast Cancer-Related Leptomeningeal Metastasis

Anne Constanze Regierer et al. Breast Care (Basel). 2008.

Abstract
in English, German

BACKGROUND: Leptomeningeal metastasis (LM) is a devastating complication of advanced cancer. Despite aggressive therapy survival is very poor. METHODS: Data of all breast cancer patients with LM were retrospectively analyzed (n = 27). RESULTS: Median survival was 9 weeks. Patients with contrast-enhancing meningeal lesions (n = 11) detected by MRI had a median survival of 33 weeks versus 8 weeks for patients without contrast-enhancing lesions (n = 9; p = 0.0407). Patients who received systemic chemotherapy (n = 18) had a median survival of 15 weeks versus 7 weeks (n = 9; p = 0.0106). Patients undergoing radiotherapy (n = 8) had a median survival of 17 weeks as compared to 5 weeks for patients without radiotherapy (n = 18; p = 0.0188). In a multiple Cox regression analysis, lack of systemic therapy (hazard ratio, HR 89.5; p = 0.002) and negative hormone receptor status (HR 4.2; p = 0.027) emerged as significant main risk factors, together with contrast-enhancing lesion as effect modifier for systemic therapy (p = 0.03). CONCLUSION: Contrast-enhancing meningeal lesions, systemic therapy, and radiotherapy were significantly associated with longer survival. Patients with contrast-enhancing lesions who were treated systemically had the longest survival. Evidence is increasing that systemic therapy plays an important role and should be applied in breast cancer patients with LM.

Hintergrund: Meningeosis carcinomatosa ist eine sehr ernst zu nehmende Verlaufsform fortgeschrittener Krebserkrankungen. Trotz aggressiver multimodaler Therapie ist das mediane Überleben sehr kurz.

Methoden: Die Daten aller Mammakarzinompatientinnen mit Meningeosis carcinomatosa wurden retrospektiv analysiert (n = 27).

Ergebnisse: Das mediane Überleben betrug 9 Wochen. Patienten mit kontrastmittelaufnehmenden meningealen Läsionen (n = 11), die durch MRT entdeckt wurden, hatten ein medianes Überleben von 33 Wochen versus 8 Wochen bei Patienten, die diese Läsionen nicht aufwiesen (n = 9; p = 0,0407). Patienten, die eine systemische Therapie erhielten (n = 18), hatten ein medianes Überleben von 15 Wochen versus 7 Wochen (n = 9; p = 0,0106). Patienten, die bestrahlt wurden (n = 8), hatten ein medianes Überleben von 17 Wochen versus 5 Wochen (n = 18; p = 0,0188). In einer multiplen Cox-Re-gressionsanalyse stellten sich die Abwesenheit einer systemischen Therapie (Hazard Ratio, HR 89,5; p = 0,002) und ein negativer Hormonrezeptorstatus (HR 4,2; p = 0,027) als Risikofaktoren heraus. Zudem wurde im Interaktionsmodell kontrastmittelspeichernde Läsion als Effektmodifizierer für die systemische Therapie identifiziert (p = 0,03).

Schlussfolgerung: Kontrastmittelaufnehmende meningeale Läsionen, systemische Therapie und Strahlentherapie waren signifikant mit einem längeren Überleben assoziiert. Patienten mit kontrastmittelaufnehmenden Läsionen, die systemisch behandelt wurden, hatten das längste Überleben. Wir können weitere Hinweise dafür liefern, dass systemische Therapie bei Brustkrebs-induzierter Meningeosis carcinomatosa wirksam ist und daher Bestandteil des multimodalen Behandlungskonzepts sein sollte.

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Figures

Fig. 1
Fig. 1
Overall survival in groups of patients with (n = 11) and without (n = 9) contrast-enhancing lesions detected in MRI (p = 0.0407). Solid line: enhancing lesion; dotted line: no enhancing lesion.
Fig. 2
Fig. 2
Overall survival in the four groups of patients in the interaction model: meningeal lesion and systemic therapy. Patients with contrast-enhancing lesions profited most from systemic therapy, whereas contrast-enhancing lesion had no benefit in the group of patients who were not treated systemically. Bold solid line: systemic therapy, enhancing lesion; bold dotted line: systemic therapy, no enhancing lesion; thin solid line: no systemic therapy, enhancing lesion; thin dotted line: no systemic therapy, no enhancing lesion.
See this image and copyright information in PMC

References

    1. Taillibert S, Laigle-Donadey F, Chodkiewicz C, Sanson M, Hoang-Xuan K, Delattre JY. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol. 2005;75(1):85–99. - PubMed
    1. Bokstein F, Lossos A, Siegal T. Leptomeningeal metastases from solid tumors: a comparison of two prospective series treated with and without intracerebrospinal fluid chemotherapy. Cancer. 1998;82(9):1756–63. - PubMed
    1. Fizazi K, Asselain B, Vincent-Salomon A, Jouve M, Dieras V, Palangie T, Beuzeboc P, Dorval T, Pouillart P. Meningeal carcinomatosis in patients with breast carcinoma. Clinical features, prognostic factors, and results of a high-dose intrathecal methotrexate regimen. Cancer. 1996;77(7):1315–23. - PubMed
    1. Boogerd W, Hart AA, van der Sande JJ, Engelsman E. Meningeal carcinomatosis in breast cancer. Prognostic factors and influence of treatment. Cancer. 1991;67(6):1685–95. - PubMed
    1. Kerr JZ, Berg S, Blaney SM. Intrathecal chemotherapy. Crit Rev Oncol Hematol. 2001;37(3):227–36. - PubMed