Leptomeningeal metastases in glioma: The Memorial Sloan Kettering Cancer Center experience

Abstract

Objective: To perform a retrospective analysis examining the incidence and prognosis of glioma patients with leptomeningeal disease (LMD) at Memorial Sloan Kettering Cancer Center over a 15-year period and correlate these findings with clinicopathologic characteristics.

Methods: We conducted a retrospective review of glioma patients with LMD at Memorial Sloan Kettering Cancer Center diagnosed from 2001 to 2016. Patients were identified through a keyword search of their electronic medical record and by ICD-9 codes.

Results: One hundred three patients were identified with disseminated LMD and 85 patients with subependymal spread of disease, 4.7% of all patients with glioma. These cohorts were analyzed separately for time to development of disseminated LMD/subependymal LMD, median overall survival, and survival from LMD diagnosis. Patients were pooled for subsequent analyses (n = 188) because of comparable clinical behavior. LMD was present at glioma diagnosis in 10% of patients. In the remaining 90% of patients diagnosed at recurrence, time to LMD diagnosis, survival after LMD diagnosis, and overall survival varied by original histology. Patients with oligodendroglioma had a median survival of 10.8 (range 1.8-67.7) months, astrocytoma 6.5 (0.1-28.5) months, and glioblastoma 3.8 (0.1-32.6) months after LMD diagnosis. In addition, we found that treatment of LMD was associated with superior performance status and increased survival.

Conclusion: Patients with LMD diagnosed at relapse may not have decreased overall survival as compared to historical controls with parenchymal relapse and may benefit from treatment.

Figure 1. MRIs of leptomeningeal tumor spread in patients with glioma

(A) Sagittal T1-post contrast of the lower spine demonstrating superficial enhancement (red arrows) along the distal cord, conus medullaris, and cauda equina nerve roots secondary to LMD in a patient with anaplastic astrocytoma. (B) Axial T1 postcontrast brain MRI showing superficial leptomeningeal enhancement along the cerebellar folia and surface of the pons in a patient with glioblastoma. (C) Axial T1 postcontrast brain MRI showing subependymal LMD (white arrow) in a patient with anaplastic oligodendroglioma. The primary tumor site (D) was contralateral to and distant from the new subependymal disease. LMD = leptomeningeal disease.

Figure 2. Median survival times

(A) Median survival in GBM was 21.7 (range 3.1–99.1) months for subependymal LMD and 16.3 (5.3–83.7) months for disseminated LMD (p = 0.21). (B) Median survival was 8.3 (range 1.5–25.9) months for patients whose LMD was present at GBM diagnosis and 17.1 (3.1–82) months for those with LMD diagnosed at recurrence (p < 0.0001). GBM = glioblastoma; LMD = leptomeningeal disease.

Figure 3. Time to LMD, overall survival, and survival from LMD in patients with glioblastoma diagnosed with LMD at recurrence

(A) Median time from glioma diagnosis was 11.9 (range 0.9–92.6) months for glioblastoma, 19.1 (1.4–202.8) months for astrocytoma, and 61.7 (3.9–274.8) months for oligodendroglioma (p < 0.0001). Median survival (B) from glioma diagnosis was 17.1 (range 3.1–99) months for glioblastoma, 33.5 (1.5–207) months for astrocytoma, and 132 (8.5–279) months for oligodendroglioma (p < 0.0001). (C) Median survival after LMD diagnosis was 3.8 (range 0.1–32.6) months for glioblastoma, 6.5 (0.1–28.5) months for astrocytoma, and 10.8 (1.8–67.7) months for oligodendroglioma (p = 0.0004). LMD = leptomeningeal disease.