Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov 1;4(1):64-68.
doi: 10.22603/ssrr.2019-0064. eCollection 2020.

Factors Linked to Prognosis in Patients with Leptomeningeal Metastasis Diagnosed by Spinal Magnetic Resonance Imaging

Hiroto Kamoda  1 , Hideyuki Kinoshita  1 , Tsukasa Yonemoto  1 , Toshihiko Iuchi  2 , Toshinori Tsukanishi  1   3 , Yoko Hagiwara  1 , Seiji Ohtori  4 , Masashi Yamazaki  3 , Takeshi Ishii  1
Affiliations

Factors Linked to Prognosis in Patients with Leptomeningeal Metastasis Diagnosed by Spinal Magnetic Resonance Imaging

Hiroto Kamoda et al. Spine Surg Relat Res. .

Abstract

Introduction: Leptomeningeal metastasis (LM) is known to demonstrate a very poor prognosis. The purpose of this study was to evaluate the prognostic factors in LM cases diagnosed by spinal magnetic resonance imaging (MRI).

Methods: We retrospectively analyzed 19 patients with LM detected by spinal MRI between 2010 and 2017.

Results: The primary tumors were breast carcinoma (n = 7), lung carcinoma (n = 6), lymphoma (n = 3), colorectal carcinoma (n = 2), and gastric carcinoma (n = 1). Thirteen patients exhibited preceding brain metastasis, and 11 of these exhibited metastasis in the posterior fossa. Ten patients exhibited limb paralysis. Performance status at diagnosis was 0-1 in 6 patients, 2 in 9 patients, and 3-4 in 4 patients. Testing of cerebrospinal fluid revealed malignant cells in 9 patients. On MRI, 11 patients demonstrated disseminated tumor lesions at the cervical cord level, 15 patients at the thoracic cord level, and 11 patients below the conus level. Eleven patients received radiation therapy, while intrathecal chemotherapy was performed in 9 patients. Univariate analysis revealed cervical cord level lesions, intrathecal chemotherapy, paralysis, and performance status as prognostic factors. Multivariate analysis identified existence of a cervical cord lesion as associated with a poor prognosis (hazards ratio (HR) 3.46, 95% confidence interval (CI) 1.12-12.2), while administration of intrathecal chemotherapy was associated with a good prognosis (HR 0.15, 95% CI 0.026-0.67).

Conclusions: In LM patients, cervical cord level lesions are a negative factor for prognosis, and performance of intrathecal chemotherapy is a positive factor for prognosis.

Keywords: cervical cord lesion; intrathecal chemotherapy; leptomeningeal metastasis; paralysis; performance status; spinal MRI.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
MRI imaging of the spinal cord. (a) leptomeningeal dissemination at cervical cord level (b) leptomeningeal dissemination at thoracic cord level (c) leptomeningeal dissemination below conus level
Figure 2.
Figure 2.
Kaplan-Meier analysis of survival related to cervical cord level lesions. The dotted line indicates patients having cervical cord level lesions, and the solid line indicates patients without cervical cord level lesions.
Figure 3.
Figure 3.
Kaplan-Meier analysis of survival related to intrathecal chemotherapy. The dotted line indicates patients without intrathecal chemotherapy, and the solid line indicates patients without cervical cord level lesions.
See this image and copyright information in PMC

References

    1. Chamberlain MC, Glantz M, Groves MD, et al. Diagnostic tools for neoplastic meningitis: detecting disease, identifying patient risk, and determining benefit of treatment. Semin Oncol. 2009;36(4):S35-45. - PubMed
    1. Chamberlain M, Soffietti R, Raizer J, et al. Leptomeningeal metastasis: a response assessment in neuro-oncology critical review of endpoints and response criteria of published randomized clinical trials. Neuro Oncol. 2014;16(9):1176-85. - PMC - PubMed
    1. Hyun JW, Jeong IH, Joung A, et al. Leptomeningeal metastasis: clinical experience of 519 cases. Eur J Cancer. 2016;56:107-14. - PubMed
    1. Waki F, Ando M, Takashima A, et al. Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors. J Neurooncol. 2009;93(2):205-12. - PubMed
    1. Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: leptomeningeal metastases in solid tumors. Surg Neurol Int. 2013;4(4):S265-88. - PMC - PubMed

LinkOut - more resources