Prognostic Factors For Patients With Leptomeningeal Metastases From Solid Tumor

To identify the factors influencing survival for patients with leptomeningeal metastases from solid tumor. Medical records of 82 patients diagnosed with leptomeningeal metastases from solid tumor from January 1, 2004 to May 31, 2011 were retrospectively reviewed. Most frequent site of origin was lung (57.1%) followed by breast (25%) and stomach (15.5%). Median age was 54 years (range:27-78) and male-female ratio was 3.8:6.2. Two thirds of the patients had performance status of ECOG class 1 or 2. Most patients were treated with intrathecal chemotherapy and whole brain RT, 85.7% and 65.5%, respectively. Systemic chemotherapy was offered to 31% and spinal RT 22.7%. Patients treated with single, dual, and triple modality were 29.3%, 42.7%, and 23.2%, respectively. The influence of each parameter on survival was tested using univariate and multivariate analyses. Survival was 2.6 months and 1 year survival rate was 9.7%. Univariate analysis revealed significantly different survival according to age (≤65 [3.0 mos] vs >65 [1.1 mos], p = 0.047), site of origin (NSCLC (4.3 mos) vs breast (2.7 mos) vs AGC (1.6 mos) vs SCLC (1.4 mos), p = 0.006), CSF leukocytosis (≥4 (2.8 mos) vs <4 (1.4 mos), p = 0.001), CSF cytology (positive (6.3 mos) vs negative (2.2 mos), p = 0.011), intrathecal chemotherapy (done (2.7 mos) vs not done (2.1 mos), p = 0.01) and systemic chemotherapy (done (7.6 mos) vs not done (1.9 mos), p < 0.001). Furthermore, number of chemotherapy regimen for primary disease (<2 (2.6 mos) vs ≥2 (2.8 mos), p = 0.064) and whole brain RT (done (3.5 mos) vs not done (2.0 mos), p = 0.062) had trend toward improved survival. Multivariate analysis revealed that positive cytology in CSF (p = 0.003), whole brain RT (p = 0.034), systemic chemotherapy (p = 0.001), and combined modality treatment (single modality 1.2 mos vs dual modality 2.5 mos (hazard ration [HR] = 0.36, 95% CI = 0.19-0.67) vs triple modality 8.3mo (hazard ration [HR] =0.16, 95% CI = 0.08-0.34) showed statistically significance on survival. Unlike previous reports, there were no significant factors among patient and symptomatic characteristics at the time of diagnosis of leptomeningeal metastases influencing survival, and survival of patients with NSCLC primary was comparable to that of breast primary, whereas SCLC and AGC were not. Furthermore, combined modality treatment improved treatment result over single modality treatment.