Leptomeningeal Carcinomatosis: Prognosis and Symptom Management

Leptomeningeal carcinomatosis meningitis occurs in approximately 5% of cancer patients, causes various symptoms including serious headache, nausea, and altered mental status, and typically has A poor prognosis. Due to lack of standardized methods for pain management, opioids are commonly used; however, these often fail to achieve sufficient analgesia. The purpose of this study was to investigate symptom management, opioid use, and overall survival in patients with leptomeningeal carcinomatosis. A retrospective review was conducted in 639 patients followed by the palliative care team in the University of Yamanashi hospital between January 2016 and December 2017. Of 19 patients diagnosed with leptomeningeal carcinomatosis, three were excluded due to loss of follow-up. For the remaining 16 patients, the original cancer type, headache, nausea, mental status change, opioid use, and overall survival were analyzed. The mean age of the patients was 59.0 (range: 18-87). The most common original cancer was lung cancer, accounting for 43.8% of patients. Thirteen patients presented with a severe headache, and most (12 patients) received either fentanyl (6), morphine (5), oxycodone (1), or tapentadol (1) for pain management. Nausea was observed in 10 patients. All patients presented with altered mental status. The median overall survival after diagnosis of leptomeningeal carcinomatosis was 90.5 days (range: 8-378 days, 95% confidence interval: 36-129 days). Patients diagnosed with leptomeningeal carcinomatosis showed poor overall survival. All patients experienced severe headaches, and most required opioids for pain management. However, it was difficult to assess the effectiveness of treatment due to altered mental status of the patients. Standardized methods for pain management are required for patients with leptomeningeal carcinomatosis.