scholarly journals Leptomeningeal Metastasis in a Breast Cancer Treated with Two Lines of Intrathecal Chemotherapy – a Case Report

2019 ◽  
Vol 32 (2) ◽  
Author(s):  
Vanda Mikudova ◽  
Katarina Rejlekova ◽  
Jan Gyarfas ◽  
Iveta Oravcova ◽  
Michal Chovanec ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Leptomeningeal Metastasis ◽  
Intrathecal Chemotherapy

Clinical improvement and survival in breast cancer leptomeningeal metastasis correlate with the cytologic response to intrathecal chemotherapy

2009 ◽  
Vol 95 (3) ◽  
pp. 421-426 ◽  
Author(s):  
Florian Clatot ◽  
Géraldine Philippin-Lauridant ◽  
Matthieu-John Ouvrier ◽  
Tony Nakry ◽  
Sophie Laberge-Le-Couteulx ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Improvement ◽  
Leptomeningeal Metastasis ◽  
Intrathecal Chemotherapy

scholarly journals LPTO-05. FACTORS INFLUENCING RISK OF LEPTOMENINGEAL METASTASIS IN BREAST CANCER PATIENTS RECEIVING STEREOTACTIC RADIOSURGERY FOR LIMITED BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i7-i7
Author(s):  
Michael Zhang ◽  
Jason Chan ◽  
Chelsea Xu ◽  
August Anderson ◽  
Ann Lazar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Cancer Patients ◽  
Leptomeningeal Metastasis ◽  
Intrathecal Chemotherapy ◽  
Cumulative Number ◽  
Breast Cancer Patients ◽  
Actuarial Risk ◽  
Clinical Records

Abstract Leptomeningeal metastasis (LM) is a late stage manifestation of advanced breast cancer frequently managed with whole brain radiotherapy (WBRT) and/or intrathecal chemotherapy. A subset of breast cancer patients who undergo stereotactic radiosurgery (SRS) for limited brain metastases (BM) ultimately develop LM. We hypothesized that this subset of high-risk patients may be identified by patient, disease, and/or treatment parameters. Clinical records from 135 consecutive breast cancer patients from a single institution who underwent SRS for BM between February 2010 and March 2018 were retrospectively analyzed. Diagnosis of LM was determined radiographically and/or by cerebrospinal fluid analysis. Demographic data, clinical history, histopathology, BM features, systemic disease burden, and prior treatments were analyzed with Cox proportional hazards regression. In our cohort, 22 (16.3%) patients ultimately developed LM. With a median follow up of 18.9 (IQR 8.6–38.7) months after diagnosis of BM, the actuarial rate of LM at 18 months was 14.5% (95% CI, 7.0–21.4%). Median OS after diagnosis of LM was 7.3 (95% CI, 3.1–15.4) months. There was significantly increased risk of LM with ≥5 vs < 5 BM at BM diagnosis (33.0% vs 7.5% [18-month actuarial risk], HR 3.5, p=0.0045), and ≥7 vs < 7 cumulative number of BM treated (21.9% vs 11.1% [18-month actuarial risk], HR 2.7, p=0.023). Variables not significantly associated with the risk of LM included tumor receptor status (ER, PR, HER2, triple negative), graded prognostic assessment, KPS, extracranial metastases, total BM volume, prior WBRT, or prior surgical resection. In conclusion, patients with a larger number of brain metastases at BM diagnosis or ≥7 cumulative number of brain metastases treated appear to be at higher risk of developing LM and may benefit from stronger consideration of WBRT, intrathecal chemotherapy, and/or brain-penetrating systemic therapy.

scholarly journals CMET-35. COMPETING RISKS ANALYSIS OF FACTORS INFLUENCING DEVELOPMENT OF LEPTOMENINGEAL METASTASIS IN BREAST CANCER PATIENTS RECEIVING STEREOTACTIC RADIOSURGERY FOR LIMITED BRAIN METASTASES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi59-vi59
Author(s):  
Michael Zhang ◽  
Ann Lazar ◽  
Jason Chan ◽  
Chelsea Xu ◽  
August Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Cancer Patients ◽  
Leptomeningeal Metastasis ◽  
Intrathecal Chemotherapy ◽  
Breast Cancer Patients ◽  
Time Intervals ◽  
Actuarial Risk ◽  
Clinical Records

Abstract Leptomeningeal metastasis (LM) is a late stage manifestation of advanced breast cancer frequently managed with whole brain radiotherapy (WBRT) and/or intrathecal chemotherapy. A subset of breast cancer patients who undergo stereotactic radiosurgery (SRS) for limited brain metastases (BM) ultimately develop LM. We hypothesized that this subset of high-risk patients may be identified by patient, disease, and/or treatment parameters. Clinical records from 133 breast cancer patients from a single institution who underwent SRS for BM between February 2010 and March 2018 were retrospectively analyzed. Variables including histopathology, BM features, systemic disease burden, and prior treatments were analyzed. Cumulative incidence rates were estimated with death as a competing risk. Dichotomous variable cutoffs were based on the 75th percentile value. In our cohort, 27 (20.3%) patients ultimately developed LM. With a median follow up of 21.2 months after diagnosis of BM, the actuarial rate of LM at 24 months was 15.2% (95% CI, 8.7%-21.7%). Median OS after diagnosis of LM was 7.0 (95% CI, 3.1–15.4) months. There was significantly increased risk of LM with ≥9 vs < 9 BM at BM diagnosis (28.1% vs 10.8% [24-month actuarial risk], subdistribution HR 2.4, p=0.027), and ≥11 vs < 11 cumulative number of BM treated (25.7% vs 11.7% [24-month actuarial risk], subdistribution HR 2.7, p=0.01). Variables not significantly associated with the risk of LM included tumor receptor status (ER, PR, HER2, triple negative), graded prognostic assessment, KPS, extracranial metastases, total BM volume, prior WBRT, or prior surgical resection. Time intervals between SRS treatments immediately preceding LM diagnosis was not significantly different from other time intervals. In conclusion, patients with a larger number of brain metastases at BM diagnosis (≥9) or cumulatively treated (≥11) appear to be at higher risk of developing LM and may benefit from stronger consideration of WBRT, intrathecal chemotherapy, and/or brain-penetrating systemic therapy.

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