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Tahir N, Ram A, Jain N, Vemireddy LP, Zahra F. Leptomeningeal Carcinomatosis in Epithelial Ovarian Cancer: A Diagnostic Challenge. Cureus 2021; 13:e14440. [PMID: 33996304 PMCID: PMC8115684 DOI: 10.7759/cureus.14440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Leptomeningeal carcinomatosis (LCM), also known as neoplastic meningitis, is a rare entity. It is generally seen in solid tumors. Ovarian cancers can infrequently cause LCM. The clinical presentation is variable. Diagnosis is made by a lumbar puncture that shows malignant cells in the cerebrospinal fluid (CSF) and usually correlates with imaging findings. Given the low individual sensitivities of lumbar puncture (55%) and magnetic resonance imaging (70%), it is recommended to combine both modalities for optimal diagnostic results. Treatment options vary depending on the type of primary carcinoma, however, the prognosis is guarded. We report a case of LCM in a patient with stage IV epithelial ovarian cancer in remission, which became a diagnostic challenge due to a lack of imaging findings.
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Affiliation(s)
- Nayha Tahir
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Aatma Ram
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Nikita Jain
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | | | - Farah Zahra
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
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O'Connor CA, Park JS, Kaley T, Kezlarian B, Edelweiss M, Yang TJ, Park W, Reidy D, Varghese AM, Yu KH, O'Reilly EM. Leptomeningeal disease in pancreas ductal adenocarcinoma: A manifestation of longevity. Pancreatology 2021; 21:599-605. [PMID: 33582005 PMCID: PMC8611374 DOI: 10.1016/j.pan.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND /Objectives: Pancreatic adenocarcinoma (PDAC) metastatic to the leptomeninges is a rare and lethal event. Leptomeningeal disease (LMD) research is limited in PDAC, and insights into clinical descriptors, possible disease predictors, and treatment strategies is necessitated. METHODS Memorial Sloan Kettering databases were queried with Institutional Review Board approval to identify patients with LMD and PDAC treated between January 2000 and June 2020. Medical record review was used to abstract clinical, genomic, pathologic, and radiographic data. Overall survival was calculated from date of PDAC diagnosis to date of death. Previously published literature on LMD from PDAC was reviewed. RESULTS Four patients with LMD from PDAC were identified, two males and two females. Age at diagnosis ranged from 57 to 68 years. All four patients had predominant lung metastasis and a relatively low burden of intra-abdominal disease. Somatic testing indicated alterations typical of PDAC and no PDAC defining pathogenic germline mutations were identified. An extended clinical course prior to LMD diagnosis was observed in all patients, ranging from 16 to 148 months. Upon diagnosis of LMD, three patients elected for supportive care and one patient received a limited course of craniospinal radiation. The median survival following diagnosis of LMD was 1.6 months (range 0.5-2.8 months). CONCLUSIONS LMD from PDAC is a rare occurrence that may be more frequent in patients with lung metastasis and/or a more indolent clinical course. Following diagnosis of LMD, prognosis is poor, and survival is short. New treatment strategies for this manifestation of PDAC are needed.
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Affiliation(s)
| | - Jennifer S Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA
| | - Thomas Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, USA
| | - Brie Kezlarian
- Department of Pathology, Memorial Sloan Kettering Cancer Center, USA
| | - Marcia Edelweiss
- Department of Pathology, Memorial Sloan Kettering Cancer Center, USA
| | - T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, USA
| | - Wungki Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Department of Medicine, Weill Cornell Medical College, USA; David M. Rubenstein Center for Pancreas Cancer Research, USA
| | - Diane Reidy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Department of Medicine, Weill Cornell Medical College, USA; David M. Rubenstein Center for Pancreas Cancer Research, USA
| | - Anna M Varghese
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Department of Medicine, Weill Cornell Medical College, USA; David M. Rubenstein Center for Pancreas Cancer Research, USA
| | - Kenneth H Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Department of Medicine, Weill Cornell Medical College, USA; David M. Rubenstein Center for Pancreas Cancer Research, USA
| | - Eileen M O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Department of Medicine, Weill Cornell Medical College, USA; David M. Rubenstein Center for Pancreas Cancer Research, USA.
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Tagami K, Matsuoka H, Ariyoshi K, Oyamada S, Hiratsuka Y, Kizawa Y, Koyama A, Inoue A. The current clinical use of adjuvant analgesics for refractory cancer pain in Japan: a nationwide cross-sectional survey. Jpn J Clin Oncol 2021; 50:1434-1441. [PMID: 32869060 DOI: 10.1093/jjco/hyaa147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although adjuvant analgesics are used to treat opioid-refractory cancer pain, there is insufficient evidence to support this practice and limited data to guide the choice depending on cancer pain pathophysiology, dose titration and starting dose. This survey aimed to clarify the current use of adjuvant analgesics for treating opioid-refractory cancer pain. METHODS In this cross-sectional study, we sent an online survey questionnaire to 208 certified palliative care specialists. Primary outcomes were (i) effective pathophysiological mechanism of cancer pain and (ii) initiating doses and time period to the first response to each adjuvant analgesic therapy. RESULTS In total, 87 (42%) palliative care specialists responded. Of all patients with cancer pain, 40% of patients (median) with refractory cancer pain were prescribed adjuvant analgesics. Additionally, 94.3, 93.1 and 86.2% of palliative care specialists found dexamethasone/betamethasone effective for neuropathic pain caused by tumor-related spinal cord compression, pregabalin effective for malignant painful radiculopathy and dexamethasone/betamethasone effective for brain tumor or leptomeningeal metastases-related headache, respectively. The median starting dose of pregabalin, dexamethasone/betamethasone, lidocaine and ketamine were 75, 4, 200, and 50 mg/day, respectively, and the median time to the first response of those medications were 5, 3, 2 and 3 days, respectively. CONCLUSIONS Many palliative care specialists select adjuvant analgesics depending on the pathophysiological mechanism of cancer pain in each case. They used such adjuvant analgesics in low doses for cancer pain with short first-response periods.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiromichi Matsuoka
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan.,Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuko Koyama
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Glasser M, Chen J, Alzarah M, Wallace M. Non-opioid Analgesics and Emerging Therapies. Cancer Treat Res 2021; 182:125-142. [PMID: 34542880 DOI: 10.1007/978-3-030-81526-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pain is a common and debilitating symptom of cancer. Cancer-related pain can occur at any point along the continuum from diagnosis to treatment to survivorship1. A systematic review published in 2016 estimated the prevalence of cancer pain to be 55% in those undergoing antineoplastic treatment, 66.4% in advanced cancer, and 39.3% in the post-treatment population. Thirty-eight percent of cancer patients in this pooled analysis experienced moderate to severe pain2.
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Affiliation(s)
- Marga Glasser
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
| | - Jeffrey Chen
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA.
| | - Mohammed Alzarah
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
| | - Mark Wallace
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
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Shimizu T, Demura S, Kato S, Shinmura K, Yokogawa N, Yonezawa N, Oku N, Kitagawa R, Handa M, Annen R, Nojima T, Murakami H, Tsuchiya H. Radiation Disrupts the Protective Function of the Spinal Meninges in a Mouse Model of Tumor-induced Spinal Cord Compression. Clin Orthop Relat Res 2021; 479:163-176. [PMID: 32858719 PMCID: PMC7899484 DOI: 10.1097/corr.0000000000001449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent advances in multidisciplinary treatments for various cancers have extended the survival period of patients with spinal metastases. Radiotherapy has been widely used to treat spinal metastases; nevertheless, long-term survivors sometimes undergo more surgical intervention after radiotherapy because of local tumor relapse. Generally, intradural invasion of a spinal tumor seldom occurs because the dura mater serves as a tissue barrier against tumor infiltration. However, after radiation exposure, some spinal tumors invade the dura mater, resulting in leptomeningeal dissemination, intraoperative dural injury, or postoperative local recurrence. The mechanisms of how radiation might affect the dura have not been well-studied. QUESTIONS/PURPOSES To investigate how radiation affects the spinal meninges, we asked: (1) What is the effect of irradiation on the meningeal barrier's ability to protect against carcinoma infiltration? (2) What is the effect of irradiation on the meningeal barrier's ability to protect against sarcoma infiltration? (3) What is the effect of irradiation on dural microstructure observed by scanning electron microscopy (SEM)? (4) What is the effect of irradiation on dural microstructure observed by transmission electron microscopy (TEM)? METHODS Eighty-four 10-week-old female ddY mice were randomly divided into eight groups: mouse mammary tumor (MMT) implantation 6 weeks after 0-Gy irradiation (nonirradiation) (n = 11), MMT implantation 6 weeks after 20-Gy irradiation (n = 10), MMT implantation 12 weeks after nonirradiation (n = 10), MMT implantation 12 weeks after 20-Gy irradiation (n = 11), mouse osteosarcoma (LM8) implantation 6 weeks after nonirradiation (n = 11), LM8 implantation 6 weeks after 20-Gy irradiation (n = 11), LM8 implantation 12 weeks after nonirradiation (n = 10), and LM8 implantation 12 weeks after 20-Gy irradiation (n = 10); female mice were used for a mammary tumor metastasis model and ddY mice, a closed-colony mice with genetic diversity, were selected to represent interhuman diversity. Mice in each group underwent surgery to generate a tumor-induced spinal cord compression model at either 6 weeks or 12 weeks after irradiation to assess changes in the meningeal barrier's ability to protect against tumor infiltration. During surgery, the mice were implanted with MMT (representative of a carcinoma) or LM8 tumor. When the mice became paraplegic because of spinal cord compression by the growing implanted tumor, they were euthanized and evaluated histologically. Four mice died from anesthesia and 10 mice per group were euthanized (MMT-implanted groups: MMT implantation occurred 6 weeks after nonirradiation [n = 10], 6 weeks after irradiation [n = 10], 12 weeks after nonirradiation [n = 10], and 12 weeks after irradiation [n = 10]; LM8-implanted groups: LM8 implantation performed 6 weeks after nonirradiation [n = 10], 6 weeks after irradiation [n = 10], 12 weeks after nonirradiation [n = 10], and 12 weeks after irradiation [n = 10]); 80 mice were evaluated. The spines of the euthanized mice were harvested; hematoxylin and eosin staining and Masson's trichrome staining slides were prepared for histologic assessment of each specimen. In the histologic assessment, intradural invasion of the implanted tumor was graded in each group by three observers blinded to the type of tumor, presence of irradiation, and the timing of the surgery. Grade 0 was defined as no intradural invasion with intact dura mater, Grade 1 was defined as intradural invasion with linear dural continuity, and Grade 2 was defined as intradural invasion with disruption of the dural continuity. Additionally, we euthanized 12 mice for a microstructural analysis of dura mater changes by two observers blinded to the presence of irradiation. Six mice (three mice in the 12 weeks after nonirradiation group and three mice in the 12 weeks after 20-Gy irradiation group) were quantitatively analyzed for defects on the dural surface with SEM. The other six mice (three mice in the 12 weeks after nonirradiation group and three mice in the 12 weeks after 20-Gy irradiation group) were analyzed for layer structure of collagen fibers constituting dura mater by TEM. In the SEM assessment, the number and size of defects on the dural surface on images (200 μm × 300 μm) at low magnification (× 2680) were evaluated. A total of 12 images (two per mouse) were evaluated for this assessment. The days from surgery to paraplegia were compared between each of the tumor groups using the Kruskal-Wallis test. The scores of intradural tumor invasion grades and the number of defects on dural surface per SEM image were compared between irradiation group and nonirradiation group using the Mann-Whitney U test. Interobserver reliabilities of assessing intradural tumor invasion grades and the number of dural defects on the dural surface were analyzed using Fleiss'κ coefficient. P values < 0.05 were considered statistically significant. RESULTS There was no difference in the median (range) time to paraplegia among the MMT implantation 6 weeks after nonirradiation group, the 6 weeks after irradiation group, the 12 weeks after nonirradiation group, and the 12 weeks after irradiation group (16 days [14 to 17] versus 14 days [12 to 18] versus 16 days [14 to 17] versus 14 days [12 to 15]; χ2 = 4.7; p = 0.19). There was also no difference in the intradural invasion score between the MMT implantation 6 weeks after irradiation group and the 6 weeks after nonirradiation group (8 of 10 Grade 0 and 2 of 10 Grade 1 versus 10 of 10 Grade 0; p = 0.17). On the other hand, there was a higher intradural invasion score in the MMT implantation 12 weeks after irradiation group than the 12 weeks after nonirradiation group (5 of 10 Grade 0, 3 of 10 Grade 1 and 2 of 10 Grade 2 versus 10 of 10 Grade 0; p = 0.02). Interobserver reliability of assessing intradural tumor invasion grades in the MMT-implanted group was 0.94. There was no difference in the median (range) time to paraplegia among in the LM8 implantation 6 weeks after nonirradiation group, the 6 weeks after irradiation group, the 12 weeks after nonirradiation group, and the 12 weeks after irradiation group (12 days [9 to 13] versus 10 days [8 to 13] versus 11 days [8 to 13] versus 9 days [6 to 12]; χ2 = 2.4; p = 0.50). There was also no difference in the intradural invasion score between the LM8 implantation 6 weeks after irradiation group and the 6 weeks after nonirradiation group (7 of 10 Grade 0, 1 of 10 Grade 1 and 2 of 10 Grade 2 versus 8 of 10 Grade 0 and 2 of 10 Grade 1; p = 0.51), whereas there was a higher intradural invasion score in the LM8 implantation 12 weeks after irradiation group than the 12 weeks after nonirradiation group (3 of 10 Grade 0, 3 of 10 Grade 1 and 4 of 10 Grade 2 versus 8 of 10 Grade 0 and 2 of 10 Grade 1; p = 0.04). Interobserver reliability of assessing intradural tumor invasion grades in the LM8-implanted group was 0.93. In the microstructural analysis of the dura mater using SEM, irradiated mice had small defects on the dural surface at low magnification and degeneration of collagen fibers at high magnification. The median (range) number of defects on the dural surface per image in the irradiated mice was larger than that of nonirradiated mice (2 [1 to 3] versus 0; difference of medians, 2/image; p = 0.002) and the median size of defects was 60 μm (30 to 80). Interobserver reliability of assessing number of defects on the dural surface was 1.00. TEM revealed that nonirradiated mice demonstrated well-organized, multilayer structures, while irradiated mice demonstrated irregularly layered structures at low magnification. At high magnification, well-ordered cross-sections of collagen fibers were observed in the nonirradiated mice. However, disordered alignment of collagen fibers was observed in irradiated mice. CONCLUSION Intradural tumor invasion and disruptions of the dural microstructure were observed in the meninges of mice after irradiation, indicating radiation-induced disruption of the meningeal barrier. CLINICAL RELEVANCE We conclude that in this form of delivery, radiation is associated with disruption of the dural meningeal barrier, indicating a need to consider methods to avoid or limit Postradiation tumor relapse and spinal cord compression when treating spinal metastases so that patients do not experience intradural tumor invasion. Surgeons should be aware of the potential for intradural tumor invasion when they perform post-irradiation spinal surgery to minimize the risks for intraoperative dural injury and spinal cord injury. Further research in patients with irradiated spinal metastases is necessary to confirm that the same findings are observed in humans and to seek irradiation methods that prevent or minimize the disruption of meningeal barrier function.
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Affiliation(s)
- Takaki Shimizu
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoru Demura
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Kato
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuya Shinmura
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriaki Yokogawa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noritaka Yonezawa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Norihiro Oku
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Kitagawa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Makoto Handa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryohei Annen
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takayuki Nojima
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideki Murakami
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Fu JB, Ng AH, Molinares DM, Pingenot EA, Morishita S, Silver JK, Bruera E. Rehabilitation Utilization by Cancer Patients with Pathology-Confirmed Leptomeningeal Disease Receiving Intrathecal Chemotherapy. Am J Phys Med Rehabil 2021; 100:100-104. [PMID: 33534219 DOI: 10.1097/phm.0000000000001565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The incidence of leptomeningeal disease (LMD) is believed to be increasing in part because of more effective chemotherapy treatments allowing cancer progression behind the blood-brain barrier. However, little has been published about the rehabilitation of this growing patient population. In this study, impairments and rehabilitation utilization by cytology-proven LMD patients receiving intrathecal chemotherapy at a cancer center are described. A total of 109 consecutive patients with pathology-confirmed LMD who received an intrathecal chemotherapy infusion from January 1, 2017, through October 31, 2017, were retrospectively reviewed. Of the 109 patients, 103 (95%) had impairments described in their medical record that could impact physical function, including 74 of 109 (68%) who had deconditioning or fatigue. Kaplan-Meier median survival from initial LMD diagnosis was 13.1 mos. The median number of hospital admissions and intrathecal chemotherapy administrations was both 8. Of the 109 patients, 43 (39%) had magnetic resonance imaging radiology interpreted LMD. Most LMD patients used rehabilitation services (95/109, 87%) and most were able to forego post-acute inpatient rehabilitation facilities (96/109, 88%). Additional research and education for rehabilitation professionals about this increasingly common syndrome are needed.
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Affiliation(s)
- Jack B Fu
- From the Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas (JBF, AHN, EB); Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, Florida (DMM); College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, Missouri (EAP); Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan (SM); and Department of Physical Medicine & Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts (JKS)
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107
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Deol M, Palotai M, Pinzon AM, Marciniak A, Bliault G, Covert E, Aizer A, Guenette JP, Desalvo MN, Li XT, Thomas A, Tran NA, Jacobson A, Huang R, Guttmann CRG. Identification and Characterization of Leptomeningeal Metastases Using SPINE, A Web-Based Collaborative Platform. J Neuroimaging 2020; 31:324-333. [PMID: 33332686 DOI: 10.1111/jon.12820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Leptomeningeal metastases (LMs) carry a poor prognosis. Existing LM scoring systems show limited reproducibility. We assessed the contribution of education level on the reproducibility of LM scoring using structured planning and implementation of new experiments (SPINE), a novel web-based platform. METHODS Stringent radiological definitions of LM and a customized interactive scoring system were implemented in SPINE. Five patients with brain LM and 3 patients with spine, but no brain LM, were selected. Each patient's baseline post-contrast T1-weighted brain MRI was analyzed by three attending neuroradiologists, two neuroradiology fellows, and two radiology residents. Raters identified and characterized all LMs based on: (1) location (cerebrum, cerebellum, brainstem, ventricle, and/or cranial nerves); (2) shape (nodular and/or linear/curvilinear); (3) size (≥ or <5mm in two orthogonal diameters); (4) spatial extension (focal or diffuse). Inter-rater agreement and association of LM with patient survival were investigated. RESULTS On average, 6.5 LMs per case were detected. Forty-nine percent of LMs were cerebral, 77.7% were nodular, 86.6% were focal, and 66% were <5 × 5 mm. Agreement on the total number of LMs and the above-mentioned common LM characteristics was higher between attendings (intra-class correlation [ICC] = 0.8-0.94) than fellows (ICC = 0.6-0.82) or residents (ICC = 0.43-0.73). Agreement on ventricular, cranial nerve, and nodular + linear LM was low even between attendings. The number of brainstem LMs showed significant correlation with survival. CONCLUSION Structured education using SPINE may improve consistency in LM reporting. Future work should address the impact of the presented approach on the reproducibility of longitudinal analyses directly relevant to the assessment of treatment-response.
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Affiliation(s)
- Madhvi Deol
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfredo Morales Pinzon
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Marciniak
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Bliault
- Bio-imaging Institute, University of Bordeaux, Bordeaux, France
| | - Etta Covert
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychology, Simmons University, Boston, MA, USA
| | - Ayal Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew N Desalvo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiao Tian Li
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Thomas
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ngoc-Anh Tran
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alex Jacobson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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108
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Adil SM, Hodges SE, Edwards RM, Charalambous LT, Yang Z, Kiyani M, Musick A, Parente BA, Lee HJ, Peters KB, Fecci PE, Lad SP. Health care resource utilization and treatment of leptomeningeal carcinomatosis in the United States. Neurooncol Pract 2020; 7:636-645. [PMID: 33312678 DOI: 10.1093/nop/npaa041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The economic burden of cancer in the United States is substantial, and better understanding it is essential in informing health care policy and innovation. Leptomeningeal carcinomatosis (LC) represents a late complication of primary cancer spreading to the leptomeninges. Methods The IBM MarketScan Research databases were queried for adults diagnosed with LC from 2001 to 2015, secondary to 4 primary cancers (breast, lung, gastrointestinal, and melanoma). Health care resource utilization (HCRU) and treatment utilization were quantified at baseline (1-year pre-LC diagnosis) and 30, 90, and 365 days post-LC diagnosis. Results We identified 4961 cases of LC (46.3% breast cancer, 34.8% lung cancer, 13.5% gastrointestinal cancer, and 5.4% melanoma). The median age was 57.0 years, with 69.7% female and 31.1% residing in the South. Insurance status included commercial (71.1%), Medicare (19.8%), and Medicaid (9.1%). Median follow-up was 66.0 days (25th percentile: 24.0, 75th percentile: 186.0) and total cumulative costs were highest for the gastrointestinal subgroup ($167 768) and lowest for the lung cancer subgroup ($145 244). There was considerable variation in the 89.6% of patients who used adjunctive treatments at 1 year, including chemotherapy (64.3%), radiotherapy (57.6%), therapeutic lumbar puncture (31.5%), and Ommaya reservoir (14.5%). The main cost drivers at 1 year were chemotherapy ($62 026), radiation therapy ($37 076), and specialty drugs ($29 330). The prevalence of neurologic impairments was 46.9%, including radiculopathy (15.0%), paresthesia (12.3%), seizure episode/convulsive disorder not otherwise specified (11.0%), and ataxia (8.0%). Conclusions LC is a devastating condition with an overall poor prognosis. We present the largest study of LC in this real-world study, including current treatments, with an emphasis on HCRU. There is considerable variation in the treatment of LC and significant health care costs.
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Affiliation(s)
- Syed M Adil
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
| | - Sarah E Hodges
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
| | - Ryan M Edwards
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
| | | | - Zidanyue Yang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, US
| | - Musa Kiyani
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
| | - Alexis Musick
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
| | - Beth A Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, US
| | - Katherine B Peters
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, US
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, US
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, US
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109
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Fernandes L, de Matos LV, Cardoso D, Saraiva M, Medeiros-Mirra R, Coelho A, Miranda H, Martins A. Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review. CNS Oncol 2020; 9:CNS65. [PMID: 33078616 PMCID: PMC7737195 DOI: 10.2217/cns-2020-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Leptomeningeal disease (LMD) represents a devastating complication of advanced breast cancer (ABC), with survival of <5 months with multimodal treatment. The role of endocrine therapy (ET), due to its favorable toxicity profile and first-line indication in luminal ABC, appears promising in the setting of LMD, where symptom stabilization and quality-of-life preservation are the main goals; however, evidenced-based data are lacking. We conducted a thorough review of published evidence, aiming to investigate the role of ET in LMD treatment in luminal ABC. Twenty-one of 342 articles, evaluating 1302 patients, met inclusion criteria. ET use was rarely reported. New targeted agents show CNS activity. Research is lacking on the role of ET and targeted agents in BC-LMD treatment.
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Affiliation(s)
- Leonor Fernandes
- Department of Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal
| | - Leonor Vasconcelos de Matos
- Department of Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal
| | - Débora Cardoso
- Department of Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal
| | - Marlene Saraiva
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, 1349-019 Lisboa, Portugal
| | - Renata Medeiros-Mirra
- Cardiff School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Cardiff CF10 3AT, Wales, UK
| | - Andreia Coelho
- Department of Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal
| | - Helena Miranda
- Department of Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal
| | - Ana Martins
- Department of Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal
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110
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Pech J, Akhøj M, Forman J, Kessing LV, Knorr U. The impact of a new affective episode on psychosocial functioning, quality of life and perceived stress in newly diagnosed patients with bipolar disorder: A prospective one-year case-control study. J Affect Disord 2020; 277:486-494. [PMID: 32877873 DOI: 10.1016/j.jad.2020.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/13/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bipolar disorder (BD) has been associated with impaired functioning during periods of euthymia. This prospective one-year case-control study investigated the impact of a new affective episode on psychosocial functioning, quality of life (QoL) and perceived stress in newly diagnosed patients with BD in euthymia. METHODS Clinically evaluated psychosocial functioning (Functioning Assessment Short Test, FAST), self-reported QoL (WHOQoL-BREF scale) and stress (Cohens' Perceived Stress Scale) were collected from 87 patients with BD with (BD-E) (n=38) and without (BD-NE) (n=44) clinical relapse and 44 age and gender matched healthy control (HC) individuals at baseline (T0), following an episode if it occurred (T2) and at one-year follow-up (T3). RESULTS Patients with BD presented with poorer functioning compared to HC individuals at T0 and T3. There was no statistically significantly difference in the changes in FAST (-1.2, adjusted-p=0.82), PSS (0.34, adjusted-p=0.93) or WHOQoL (-0.67, adjusted-p=0.93) between BD-E and BD-NE during the one-year follow-up. The subgroup BD-E had statistically significantly higher FAST and stress scores and lower WHOQoL-scores compared to BD-NE at both T0 and T3. LIMITATIONS Modest sample size. CONCLUSION Functioning is impaired in newly diagnosed patients with BD in a euthymic state, however, a new affective episode does not affect functioning during subsequent euthymia at one-year follow-up. Patients with BD-E presented with overall most impaired functioning, highlighting the importance of early intervention strategies as essential to identify and treat patients at high risk of relapse and poor outcome.
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Affiliation(s)
- Josefine Pech
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Department O, Section 6233, Rigshospitalet, Blegdamsvej 9, University of Copenhagen, Faculty of Health and Medical Sciences, 2100 Copenhagen, Denmark
| | - Morten Akhøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Julie Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Department O, Section 6233, Rigshospitalet, Blegdamsvej 9, University of Copenhagen, Faculty of Health and Medical Sciences, 2100 Copenhagen, Denmark
| | - Ulla Knorr
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Department O, Section 6233, Rigshospitalet, Blegdamsvej 9, University of Copenhagen, Faculty of Health and Medical Sciences, 2100 Copenhagen, Denmark.
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111
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Lasocki A, Caspersz LJ. T2-SPACE imaging of the cauda equina for the assessment of leptomeningeal metastatic disease. J Clin Neurosci 2020; 81:290-294. [PMID: 33222932 DOI: 10.1016/j.jocn.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
The diagnosis of leptomeningeal metastatic disease (LMD) is frequently challenging and MRI of the spine is an important part of the diagnostic paradigm. We sought to examine the value of adding 3-dimensional, heavily T2-weighted, Sampling Perfection with Application optimised Contrasts using different flip angle Evolution (T2-SPACE) imaging of the lumbar spine to the MRI protocol for patients with suspected LMD. MRI spine examinations including T2-SPACE imaging of the lumbar spine performed for suspected or known LMD were retrospectively reviewed by a neuroradiologist to determine the additional benefit of the T2-SPACE sequence. The accuracy of T2-SPACE was also compared to contrast-enhanced T1-weighted imaging (ceT1WI) and standard T2-weighted imaging (T2WI). 59 patients with T2-SPACE were identified over a 20-month period, 17 having abnormal appearances on ceT1WI, including 12 with appearances consistent with LMD. In eight of these 12 patients, nodules visible on T2-SPACE were visible on T2WI, though T2-SPACE improved the temporal comparison of slowly progressive cauda equina nodules in two cases. In three patients, T2-SPACE identified nodules which were not readily identifiable on T2WI, though were visible on ceT1WI. In one patient, LMD visible on ceT1WI was not appreciable on T2-SPACE or T2WI due to the lack of a nodular component. In six patients, T2WI showed equivocal nodularity, which could be confidently attributed to facet joint arthropathy or a tortuous vessel. In conclusion, T2-SPACE has high sensitivity and specificity for the detection of nodular lesions of the cauda equina and can confidently characterise equivocal findings on standard T2WI.
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Affiliation(s)
- Arian Lasocki
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum, Department of Oncology, The University of Melbourne, Victoria 3010, Australia.
| | - Lauren J Caspersz
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
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112
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Abstract
The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.
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Affiliation(s)
- Joshua T Wewel
- Atlanta Brain and Spine Care, Piedmont Healthcare, Atlanta, Georgia
| | - John E O'Toole
- Department of Neurosurgery, University Medical Center, Chicago, Illinois, US
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113
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Mulroy E, Anderson NE. Altered mental status in "Guillain-Barré syndrome" -a noteworthy clinical clue. Ann Clin Transl Neurol 2020; 7:2489-2507. [PMID: 33136342 PMCID: PMC7732251 DOI: 10.1002/acn3.51226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/19/2020] [Accepted: 09/26/2020] [Indexed: 01/01/2023] Open
Abstract
Guillain‐Barré syndrome (GBS) is widely regarded as a “pure” peripheral nervous system disorder. However, this simplistic interpretation belies the fact that central nervous system involvement, often manifesting as derangements in mental status can occur as a complication of the “pure” form of the disorder, as part of GBS variants, as well as in a number of mimic disorders. Despite being common in clinical practice, there is no guidance in the literature as to how to approach such scenarios. Herein, we detail our approach to these cases.
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Affiliation(s)
- Eoin Mulroy
- UCL Queen Square Institute of Neurology, London, UK
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114
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Cheng P, Feng F, Yang H, Jin S, Lai C, Wang Y, Bi J. Detection and significance of exosomal mRNA expression profiles in the cerebrospinal fluid of patients with meningeal carcinomatosis. J Mol Neurosci 2020; 71:790-803. [PMID: 32959225 DOI: 10.1007/s12031-020-01701-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/07/2020] [Indexed: 01/05/2023]
Abstract
Exosomes are cell-derived membrane vesicles with cargo that can be transported into receiver cells to exert their biological roles. Exosomal RNA signature profiles and exosome-derived proteomics are often used to explore the molecular regulation of diseases, and can mirror the conditional state of their tissue of origin, thus serving as biomarkers. The onset of meningeal carcinomatosis (MC) is concealed, and early diagnosis is difficult. To enable early diagnosis of MC, it is essential to identify new biomarkers. Few studies have investigated the function of exosomes in MC. In this study, high-throughput sequencing was used to examine the mRNA profiles of exosomes in the cerebrospinal fluid (CSF) of patients with MC. We further analyzed the functions and signaling pathways associated with the differentially expressed genes in exosomes to reveal the putative mechanisms by which the exosomal mRNAs function in MC. In summary, this study identified biomarker candidates for MC, and provided new insights into the significant role of exosomal mRNA regulation in MC.
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Affiliation(s)
- Peng Cheng
- Department of Neural Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Feifei Feng
- Department of Respiratory Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Hui Yang
- Department of Neural Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Suqin Jin
- Department of Neural Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Chao Lai
- Department of Neural Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China.
| | - Yun Wang
- Department of Neural Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China.
| | - Jianzhong Bi
- Department of Neural Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
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115
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Keith TA, Tidmore E. Leptomeningeal metastasis presenting with blurry vision, nausea and headache. Clin Exp Optom 2020; 104:124-127. [PMID: 32945007 DOI: 10.1111/cxo.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Thomas A Keith
- School of Optometry, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center , Birmingham, Alabama, USA
| | - Eric Tidmore
- School of Optometry, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center , Birmingham, Alabama, USA
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116
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Liu Y, Li Y, Li Z, Li C, He J, Bu H. Knockdown of IKKβ Inhibits Tumor Development in a Leptomeningeal Metastasis Mouse Model and Proliferation of Lung Cancer Cells. Cancer Manag Res 2020; 12:6007-6017. [PMID: 32765100 PMCID: PMC7381159 DOI: 10.2147/cmar.s252184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022] Open
Abstract
Objective This study will explore the role of IKKβ in the leptomeningeal metastasis (LM) of lung cancer cells. Methods In vitro studies were conducted in mouse Lewis lung carcinoma (LLC) cells with IKKβ knockdown. Cell proliferation was explored using CCK-8 and tumor colony-forming assays. The expression of the extracellular signal-regulated kinase (ERK) signaling pathway was detected by Western blot. Tumor cell apoptosis was identified through Western blot detection of Bax and Bcl-2. The migration of tumor cells was identified by a wound healing assay. In vivo studies used an LM mouse model developed by injecting LLC cells with or without IKKβ knockdown into the cisterna magna. Mouse brain and spinal samples were sectioned for hematoxylin and eosin staining. Results In vitro: IKKβ knockdown inhibits tumor cell proliferation, initiates apoptosis, and attenuates cell migration. In vivo: IKKβ knockdown inhibits tumor growth in the LM mouse model. In addition, the in vitro results showed that IKKβ knockdown attenuated the expression of ERK phosphorylation in LLC cells. Conclusion Blocking the NF-κB signaling pathway by IKKβ knockdown in LLC cells inhibited tumor growth in the LM mouse model. IKKβ supports leptomeningeal tumor progression by promoting cancer cell proliferation and migration and inhibiting cancer cell apoptosis, and these actions may be correlated to ERK signaling.
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Affiliation(s)
- Yakun Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Yuanyuan Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Zhongyao Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Chunyan Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei 050000, People's Republic of China.,Institute of Cardiocerebrovascular Disease, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Junying He
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei 050000, People's Republic of China.,Institute of Cardiocerebrovascular Disease, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Hui Bu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei 050000, People's Republic of China.,Institute of Cardiocerebrovascular Disease, Shijiazhuang, Hebei 050000, People's Republic of China
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117
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Ejikeme T, de Castro GC, Ripple K, Chen Y, Giamberardino C, Bartuska A, Smilnak G, Marius C, Boua JV, Chongsathidkiet P, Hodges S, Pagadala P, Verbick LZ, McCabe AR, Lad SP. Evaluation of neurapheresis therapy in vitro: a novel approach for the treatment of leptomeningeal metastases. Neurooncol Adv 2020; 2:vdaa052. [PMID: 32642705 PMCID: PMC7236387 DOI: 10.1093/noajnl/vdaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Leptomeningeal metastases (LM), late-stage cancer when malignant cells migrate to the subarachnoid space (SAS), have an extremely poor prognosis. Current treatment regimens fall short in effectively reducing SAS tumor burden. Neurapheresis therapy is a novel approach employing filtration and enhanced circulation of the cerebrospinal fluid (CSF). Here, we examine the in vitro use of neurapheresis therapy as a novel, adjunctive treatment option for LM by filtering cells and augmenting the distribution of drugs that may have the potential to enhance the current clinical approach. Methods Clinically relevant concentrations of VX2 carcinoma cells were suspended in artificial CSF. The neurapheresis system’s ability to clear VX2 carcinoma cells was tested with and without the chemotherapeutic presence (methotrexate [MTX]). The VX2 cell concentration following each filtration cycle and the number of cycles required to reach the limit of detection were calculated. The ability of neurapheresis therapy to circulate, distribute, and maintain therapeutic levels of MTX was assessed using a cranial–spinal model of the SAS. The distribution of a 6 mg dose was monitored for 48 h. An MTX-specific ELISA measured drug concentration at ventricular, cervical, and lumbar sites in the model over time. Results In vitro filtration of VX2 cancer cells with neurapheresis therapy alone resulted in a 2.3-log reduction in cancer cell concentration in 7.5 h and a 2.4-log reduction in live-cancer cell concentration in 7.5 h when used with MTX. Cranial–spinal model experiments demonstrated the ability of neurapheresis therapy to enhance the circulation of MTX in CSF along the neuraxis. Conclusion Neurapheresis has the potential to act as an adjunct therapy for LM patients and significantly improve the standard of care.
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Affiliation(s)
- Tiffany Ejikeme
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - George C de Castro
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Katelyn Ripple
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Yutong Chen
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Charles Giamberardino
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew Bartuska
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gordon Smilnak
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Choiselle Marius
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jane-Valeriane Boua
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sarah Hodges
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Promila Pagadala
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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118
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Glitza IC, Smalley KSM, Brastianos PK, Davies MA, McCutcheon I, Liu JKC, Ahmed KA, Arrington JA, Evernden BR, Smalley I, Eroglu Z, Khushalani N, Margolin K, Kluger H, Atkins MB, Tawbi H, Boire A, Forsyth P. Leptomeningeal disease in melanoma patients: An update to treatment, challenges, and future directions. Pigment Cell Melanoma Res 2020; 33:527-541. [PMID: 31916400 PMCID: PMC10126834 DOI: 10.1111/pcmr.12861] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/26/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023]
Abstract
In February 2018, the Melanoma Research Foundation and the Moffitt Cancer Center hosted the Second Summit on Melanoma Central Nervous System Metastases in Tampa, Florida. The meeting included investigators from multiple academic centers and disciplines. A consensus summary of the progress and challenges in melanoma parenchymal brain metastases was published (Eroglu et al., Pigment Cell & Melanoma Research, 2019, 32, 458). Here, we will describe the current state of basic, translational, clinical research, and therapeutic management, for melanoma patients with leptomeningeal disease. We also outline key challenges and barriers to be overcome to make progress in this deadly disease.
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Affiliation(s)
- Isabella C. Glitza
- Department of Melanoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Keiran S. M. Smalley
- Melanoma Research Center of Excellence, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Michael A. Davies
- Department of Melanoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Ian McCutcheon
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - James K. C. Liu
- Department of Neuro-Oncology & Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran A. Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John A. Arrington
- Head of Neuroradiology Section, Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brittany R. Evernden
- Department of Neuro-Oncology & Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Inna Smalley
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Nikhil Khushalani
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kim Margolin
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Harriet Kluger
- Department of Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Michael B. Atkins
- Department of Medical Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Adrienne Boire
- Department of Neuro-Oncology, Memorial Sloan Kettering, New York, NY, USA
| | - Peter Forsyth
- Department of Neuro-Oncology & Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Huppert LA, Melisko ME, Glastonbury CM, Khanafshar E, Daud AI. Treatment of Metastatic Melanoma With Leptomeningeal Disease Using Intrathecal Immunotherapy. JCO Oncol Pract 2020; 16:757-759. [PMID: 32603255 DOI: 10.1200/op.20.00146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laura A Huppert
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Michelle E Melisko
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Christine M Glastonbury
- Division of Neuroradiology, Department of Radiology, University of California San Francisco, San Francisco, CA
| | - Elham Khanafshar
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | - Adil I Daud
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
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Dreessen L, Maréchal N, Verheyden M, De Becker A, Jochmans K, Vanderhasselt T, Bravenboer B, Beyer I. Leptomeningeal metastasis in a marginal zone lymphoma, presenting as a delirium: case report. BMC Geriatr 2020; 20:213. [PMID: 32552693 PMCID: PMC7298837 DOI: 10.1186/s12877-020-01608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hematologic malignancies can spread to the central nervous system (CNS), either as focal lesions or as leptomeningeal disease. Marginal zone lymphoma (MZL) is a low-grade non-Hodgkin lymphoma and generally presents as an indolent disease. This case report illustrates an unexpected diagnosis of leptomeningeal metastasis in an MZL, presenting as a delirium without B symptoms, pronounced hematologic progression or abnormalities on cerebral imaging. Case presentation An 80-year-old patient with a medical history of monoclonal B-cell lymphocytosis (MBL) with a clone indicative for an MZL, presented to the emergency and the geriatric departments with a recent cognitive deterioration and behavioral changes. MMSE score was 18/30. After excluding the most common etiologies through classical work-up including a normal head magnetic resonance imaging, a lumbar puncture was performed. In the cerebrospinal fluid an elevated protein level and increased lymphocyte count were identified, whereas beta-amyloid and tau protein levels were normal. Immunophenotyping of the lymphocytes confirmed CNS invasion by the MZL clone. Staging revealed mild splenomegaly. Prednisolone, intrathecal and systemic chemotherapy were initiated, leading to quick cognitive improvement with a final MMSE score of 28/30. Conclusions To the best of our knowledge a delirium in an older patient due to leptomeningeal disease in MZL has never been described. To date, rare reports of CNS invasion by MZL describe focal intracranial lesions. After exclusion of common etiologies, physicians should remain vigilant when confronted with a patient with history of MBL presenting neurological symptoms. This case illustrates the importance of low threshold for lumbar punctures in this population, also for those patients with normal imaging studies.
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Affiliation(s)
- Lisa Dreessen
- Department of Geriatric Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Nicolas Maréchal
- Department of Geriatric Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Michel Verheyden
- Department of Internal Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ann De Becker
- Department of Hematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Kristin Jochmans
- Department of Hematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Tim Vanderhasselt
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bert Bravenboer
- Department of Geriatric Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingo Beyer
- Department of Geriatric Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
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Single-arm, open-label phase 2 trial of pembrolizumab in patients with leptomeningeal carcinomatosis. Nat Med 2020; 26:1280-1284. [PMID: 32483359 DOI: 10.1038/s41591-020-0918-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 05/01/2020] [Indexed: 01/02/2023]
Abstract
An increasing fraction of patients with metastatic cancer develop leptomeningeal dissemination of disease (LMD), and survival is dismal1-3. We conducted a single-arm, phase 2 study of pembrolizumab in patients with solid tumor malignancies and LMD (NCT02886585). Patients received 200 mg of pembrolizumab intravenously every 3 weeks until definitive progression or unacceptable toxicity. The primary endpoint was rate of overall survival at 3 months (OS3). Secondary objectives included toxicity, response rate and time to intracranial or extracranial disease progression. A Simon two-stage design was used to compare a null hypothesis OS3 of 18% against an alternative of 43%. Twenty patients-17 with breast cancer, two with lung cancer and one with ovarian cancer-were enrolled into the pre-specified evaluation group having received at least one dose of pembrolizumab. The median follow-up of surviving patients was 6.3 months (range, 2.2-12.5 months). The percentage of patients who experienced one (or more) grade 3 or higher adverse events at least possibly related to treatment was 40%, the most frequent being hyperglycemia (n = 6), nausea (n = 7) and vomiting (n = 7). The study met the primary endpoint, as 12 of 20 (OS3, 0.60; 90% confidence interval, 0.39-0.78) patients were alive at 3 months after enrollment. Pembrolizumab is safe and feasible and displays promising activity in patients with LMD. Further investigations are needed to identify which patients with LMD can benefit from pembrolizumab.
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Brizzi K, Zupanc SN, Udelsman BV, Tulsky JA, Wright AA, Poort H, Lindvall C. Natural Language Processing to Assess Palliative Care and End-of-Life Process Measures in Patients With Breast Cancer With Leptomeningeal Disease. Am J Hosp Palliat Care 2020; 37:371-376. [PMID: 31698921 DOI: 10.1177/1049909119885585] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Palliative care consultation during serious life-limiting illness can reduce symptom burden and improve quality of care. However, quantifying the impact of palliative care is hindered by the limitations of manual chart review and administrative coding. OBJECTIVES Using novel natural language process (NLP) techniques, we examined associations between palliative care consultations and performance on nationally endorsed metrics for high-quality end-of-life (EOL) care in patients with leptomeningeal disease (LMD) secondary to metastatic breast cancer. METHODS Patients with breast cancer with LMD were identified using administrative billing codes and NLP review of magnetic resonance imaging reports at 2 tertiary care centers between 2010 and 2016. Next, NLP was used to review clinical notes to (1) determine the presence of palliative care consultations and (2) determine the performance of process measures associated with high-quality EOL care, including discussions of goals of care, code status limitations, and hospice. Associations between palliative care consultation and documentation of EOL process measures were assessed using logistic regression. RESULTS We identified 183 cases of LMD. Median age was 56 (interquartile range [IQR]: 46-64) years and median survival was 150 days (IQR: 67-350). Within 6 months of diagnosis, 88.5% of patients had documentation of ≥1 process measure, including discussions of goals of care (63.4%), code status limitations (62.8%), or hospice (72.1%). Palliative care consultation was a predictor of subsequent documentation of goals of care (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.58-6.27) and hospice discussions (OR, 4.61; 95% CI, 2.12-10.03). CONCLUSION Palliative care involvement is associated with increased performance of EOL process measures in patients with breast cancer with LMD.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Division of Palliative Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia N Zupanc
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brooks V Udelsman
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alexi A Wright
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hanneke Poort
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Systemic treatment of breast cancer with leptomeningeal metastases using bevacizumab, etoposide and cisplatin (BEEP regimen) significantly improves overall survival. J Neurooncol 2020; 148:165-172. [PMID: 32346837 PMCID: PMC7280357 DOI: 10.1007/s11060-020-03510-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/18/2020] [Indexed: 12/29/2022]
Abstract
Introduction Metastatic breast cancer (MBC) with leptomeningeal metastases (LM) has dismal survival. We aim to determine if modern systemic therapy, especially the bevacizumab, cisplatin, and etoposide (BEEP) regimen, is beneficial to MBC LM patients. Methods We excerpted data from a prospectively collected cytopathology database for MBC patients who were diagnosed with LM by positive cerebrospinal fluid cytology. The primary outcome was OS from cytologically confirmed LM until death. Univariate and multivariate analyses were performed to elucidate prognostic factors. Results We identified 34 patients with cytologically confirmed LM. Treatments after LM diagnosis included: intrathecal methotrexate (82.4%), systemic chemotherapy (68%; BEEP n = 19, others n = 4), and whole brain radiotherapy (n = 5, 14.7%). Three of seven HER2-positive patients (43%) also received intrathecal trastuzumab. OS was improved in 2014–2016 compared with 2011–2013 (13.57 vs 3.20 months, p = 0.004), when 12/17 (71%) versus 7/17 (41%) patients received BEEP, respectively. In the multivariate model including all treatments, BEEP (HR 0.24, p = 0.003) and intrathecal trastuzumab (HR 0.22, p = 0.035), but not intrathecal methotrexate (HR 0.86, p = 0.78), remained significant prognostic factors. Conclusions MBC with LM is treatable—systemic BEEP are efficacious and may improve survival. Electronic supplementary material The online version of this article (10.1007/s11060-020-03510-y) contains supplementary material, which is available to authorized users.
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Pan Z, Yang G, He H, Gao P, Jiang T, Chen Y, Zhao G. Identification of Cerebrospinal Fluid MicroRNAs Associated With Leptomeningeal Metastasis From Lung Adenocarcinoma. Front Oncol 2020; 10:387. [PMID: 32328453 PMCID: PMC7152668 DOI: 10.3389/fonc.2020.00387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/04/2020] [Indexed: 01/04/2023] Open
Abstract
Background: Leptomeningeal metastasis (LM) has frequently been observed in patients with lung adenocarcinoma. So far, its diagnosis and disease course monitoring are still extremely difficult. Moreover, there is no effective treatment regimen for LM due to a lack knowledge on the molecular mechanism of LM. This study aimed to identify LM-related cerebrospinal fluid (CSF) miRNAs, which have potential value for diagnosing and monitoring LM and exploring the molecular mechanism. Methods: CSF miRNAs were screened and verified by microarray analysis and quantitative real-time PCR (qRT-PCR) in LM patients with lung adenocarcinoma and non-LM controls, and the diagnostic performance of candidate miRNAs was evaluated. Then, candidate miRNAs in matched CSF samples from LM patients at diagnosis, after initial therapy, at relapse, and after salvage therapy, were analyzed to assess the relationship between CSF miRNAs and LM disease course. The effect of candidate miRNAs on proliferation, invasion, and migration of lung adenocarcinoma cell lines was assessed. The targeted genes of the candidate miRNA were predicted by TargetScan, miRDB, and miRTarbase online analysis tools. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used to analyze the functional categories of predicted target genes. Results: CSF miR-7975, miR-7977, and miR-7641 were screened and verified to be statistically significantly up-regulated in LM patients compared to non-LM controls. The three miRNAs, when combined, exhibited optimal diagnostic performance. Longitudinal data of CSF miR-7975 and miR-7977 correlated well with clinical courses of LM. Overexpression of miR-7977 promoted proliferation, migration, and invasion of lung adenocarcinoma cells. Moreover, 385 targeted genes of miR-7977 were predicted and were involved in various pathways related to cancer metastasis. Conclusions: This study offers insights for future research of CSF miRNAs as robust tools for diagnosing and monitoring LM. It also reveals a novel pathway for exploration of underlying mechanisms of LM.
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Affiliation(s)
- Zhenyu Pan
- Department of Neuro-Oncological Surgery, The First Hospital of Jilin University, Changchun, China.,Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, China.,VA Palo Alto Health Care System, Stanford University Medical School, Palo Alto, CA, United States
| | - Guozi Yang
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, China.,VA Palo Alto Health Care System, Stanford University Medical School, Palo Alto, CA, United States
| | - Hua He
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Pengxiang Gao
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, China
| | - Tongchao Jiang
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, China
| | - Yong Chen
- Department of Neuro-Oncological Surgery, The First Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Department of Neuro-Oncological Surgery, The First Hospital of Jilin University, Changchun, China
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Ikeda Y, Yoshida M, Ishikawa K, Kubo T, Murase K, Takada K, Miyanishi K, Kato J. Pancreatic cancer with leptomeningeal carcinomatosis: case report and literature review. Int Cancer Conf J 2020; 9:96-100. [PMID: 32257762 PMCID: PMC7109234 DOI: 10.1007/s13691-020-00405-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/05/2020] [Indexed: 12/26/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) associated with pancreatic cancer is an extremely rare complication. Symptoms vary depending on the site of invasion and include intracranial pressure, and cranial and spinal dysfunction making early diagnosis difficult. We describe a rare case of leptomeningeal metastasis from pancreatic cancer. A 59-year-old man was diagnosed with unresectable pancreatic cancer and subsequently received systemic chemotherapy. Initial chemotherapy was effective. After 12 months the patient's serum carbohydrate antigen (CA)19-9 level had become elevated, and he presented with neck and back pain, and shoulder stiffness. Tumor enlargement was not detected by computed tomography (CT) and positron emission tomography-CT. Contrast CT of the brain revealed evidence of leptomeningeal enhancement. Cerebrospinal fluid cytology showed atypical, but not malignant cells; the CA19-9 level was further elevated. The patient was finally diagnosed with LMC and, being in poor general condition, received palliative care. During the treatment of pancreatic cancer, the potential existence of LMC should be contemplated when a serum tumor marker becomes rapidly elevated despite the control of primary or metastatic sites.
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Affiliation(s)
- Yuki Ikeda
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Makoto Yoshida
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Kazuma Ishikawa
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Tomohiro Kubo
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Kazuyuki Murase
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Kohichi Takada
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Koji Miyanishi
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
| | - Junji Kato
- Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
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Koeller KK, Shih RY. Intradural Extramedullary Spinal Neoplasms: Radiologic-Pathologic Correlation. Radiographics 2020; 39:468-490. [PMID: 30844353 DOI: 10.1148/rg.2019180200] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
While intradural extramedullary spinal disease varies widely, identification of tumors in this location and their radiologic manifestations greatly facilitates narrowing of the diagnostic considerations. Meningioma and schwannoma are the two most common intradural extramedullary tumors, and both are associated with neurofibromatosis. Meningiomas are most common in the thoracic spine and show a strong female predilection and a clinical manifestation related to compression of the spinal cord or nerve roots. Schwannomas typically are associated with radicular pain and other sensory symptoms. Melanotic schwannoma frequently shows T1 hyperintensity at MRI related to the presence of paramagnetic free radicals in melanin. Neurofibroma, known for its T2 hyperintensity, frequently involves the cervical spine, where it may make surgical resection challenging. Less commonly, malignant peripheral nerve sheath tumor commonly mimics the imaging appearance of a schwannoma but has decidedly more aggressive biologic behavior. In the cauda equina, myxopapillary ependymoma and paraganglioma are believed to arise from the filum terminale and have characteristic imaging manifestations based on their underlying pathologic features. Recent identification of a common genetic marker has led to reclassification of what had previously been regarded as separate tumors and are now known as solitary fibrous tumor/hemangiopericytoma. In the proper clinical setting, the presence of nodular intradural enhancement strongly suggests the presence of leptomeningeal metastatic disease, even when results of cerebrospinal fluid analysis are negative. This article highlights the characteristic neuroimaging manifestations of these neoplasms, with emphasis on radiologic-pathologic correlation. See Illumination by Frazier .
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Affiliation(s)
- Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, 1011 Wayne Ave, Suite 320, Silver Spring, MD 20910 (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
| | - Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, 1011 Wayne Ave, Suite 320, Silver Spring, MD 20910 (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
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Leptomeningeal Disease as a Rare Complication of Primary Penile Urethral Cancer. Case Rep Oncol Med 2020; 2020:6349456. [PMID: 32257477 PMCID: PMC7128049 DOI: 10.1155/2020/6349456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
Primary penile urethral cancer is a rare genitourinary malignancy arising from the epithelial lining of the urethra. Our patient is a 63-year-old male with newly diagnosed penile urethral carcinoma who presented with headache and was found to have leptomeningeal disease on imaging and cerebral spinal fluid analysis. He was treated with systemic and intrathecal chemotherapy with some response and improvement in symptoms. This is the first reported case of leptomeningeal disease as a complication of penile urethral carcinoma. Recognition and prompt treatment are important; however, overall prognosis of this entity remains poor.
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Cohen JV, Wang N, Venur VA, Hadfield MJ, Cahill DP, Oh K, Brastianos PK. Neurologic complications of melanoma. Cancer 2020; 126:477-486. [DOI: 10.1002/cncr.32619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/28/2019] [Accepted: 10/08/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Justine V. Cohen
- Division of Medical Oncology and Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Nancy Wang
- Division of Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Vyshak A. Venur
- Division of Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Matthew J. Hadfield
- Division of Internal Medicine University of Connecticut Hartford Connecticut
| | - Daniel P. Cahill
- Division of Neurosurgery Massachusetts General Hospital Boston Massachusetts
| | - Kevin Oh
- Division of Radiation Oncology Massachusetts General Hospital Boston Massachusetts
| | - Priscilla K. Brastianos
- Division of Medical Oncology and Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
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Prabhash K, Vallathol D, Patil V, Noronha V, Joshi A, Menon N. Leptomeningeal metastasis from extracranial solid tumors. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_38_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bernstock JD, Ostby S, Fox B, Sotoudeh H, Janssen A, Kang YJ, Chen J, Prattipati V, Elsayed G, Chagoya G, Yamashita D, Friedman GK, Nabors B, Huh WK, Lobbous M. Cauda equina syndrome in an ovarian malignant-mixed müllerian tumor with leptomeningeal spread. Clin Case Rep 2019; 7:2341-2345. [PMID: 31893054 PMCID: PMC6935635 DOI: 10.1002/ccr3.2472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 12/27/2022] Open
Abstract
Leptomeningeal metastasis is extremely rare in patients with ovarian cancer, but should be considered in patients presenting with neurologic deficits such as cauda equine syndrome. Given its poor prognosis and lack of data currently on management, additional studies are needed to optimize treatment regimens and improve outcomes.
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Affiliation(s)
- Joshua D. Bernstock
- Department of NeurosurgeryBrigham and Women's HospitalHarvard UniversityBostonMAUSA
| | - Stuart Ostby
- Division of Gynecologic OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Brandon Fox
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Houman Sotoudeh
- Department of Radiology, Neuroradiology SectionUniversity of Alabama at BirminghamBirminghamALUSA
| | - Andrew Janssen
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Jason Chen
- Medical Scientist Training ProgramUniversity of CaliforniaLos AngelesCAUSA
| | | | - Galal Elsayed
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamALUSA
| | - Gustavo Chagoya
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamALUSA
| | - Daisuke Yamashita
- Department of NeurosurgeryBrigham and Women's HospitalHarvard UniversityBostonMAUSA
| | - Gregory K. Friedman
- Division of Pediatric Hematology and OncologyDepartment of PediatricsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Burt Nabors
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Warner K. Huh
- Division of Gynecologic OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Mina Lobbous
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamALUSA
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Liu H, Zhang J, Liu Y, Sun Y, Li C, Gu C, Wang H, Zhang H, Yu C, Zhang M. Neuraxis Metastases Of Primary Central Nervous System Tumors: A Review Of Clinicopathological And Radiographic Characters Of 198 Cases In A Single Center. Cancer Manag Res 2019; 11:9829-9841. [PMID: 31819620 PMCID: PMC6876216 DOI: 10.2147/cmar.s217672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/26/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuraxis metastases (NM) from systemic and central nervous system (CNS) tumors have become increasingly common. However, a lack of systematic information restricts the development of the accurate diagnosis and treatment. The aim of this study is to facilitate the understanding of NM arising from CNS tumors in the largest cohort. METHODS Based on the clinicopathological and neuroimaging findings, we retrospectively analyze the epidemiological characters, radiographic classification, therapeutic strategies and prognostic factors. RESULTS A total of 198 cases are enrolled and the most common primary tumor is medulloblastoma (34.34%). The median age is 15.0 years and the majority of NM (79.29%) occur in the children and young adult groups. One hundred and forty-nine (75.25%) cases suffer from intracranial metastases, and 169 (85.35%) have intraspinal NM. The whole leptomeninges and cauda equine are the most preferential disseminated sites. Upon MRI parameters, the massive and miliary subgroup occurs most frequently in the intracranial and intraspinal NM, respectively. Treatment includes surgery (21.71%), chemotherapy alone (19.19%), radiation alone (10.10%) and combined therapy (55.56%). Operations are performed in order to identify pathology and relive masses, as well as the triple chemotherapeutic scheme consisting of ifosfamide, carboplatin and etoposide is recommended for most of NM. The median overall survival is 11.6 months. Younger age, coexistence of NM with primary tumors, shorter interval from primaries to metastases, glioma, leptomeningeal seeding and nodal subtype on MRI significantly correlate with poor prognosis. CONCLUSION In spite of controversial therapies and poor outcomes, the neuroimaging classification and comprehensive treatment contribute to the efficient administration of NM.
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Affiliation(s)
- Hailong Liu
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
- Department of Neurosurgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing100853, People’s Republic of China
| | - Junping Zhang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
| | - Yongqiang Liu
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou510405, People’s Republic of China
| | - Youliang Sun
- School of Basic Medical Science, Capital Medical University, Beijing100069, People’s Republic of China
| | - Cheng Li
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
| | - Chunyu Gu
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
| | - Haoran Wang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
| | - Hongwei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
| | - Mingshan Zhang
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing100093, People’s Republic of China
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Sindhu KK, Chang S, Liu J, Bakst RL, Dharmarajan KV. In a Patient With Cancer, Not All That Enhances Is Leptomeningeal Carcinomatosis. J Oncol Pract 2019; 15:558-559. [PMID: 31600463 DOI: 10.1200/jop.19.00324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sanders Chang
- Icahn School of Medicine, New York, NY.,NYC Health + Hospitals/Elmhurst, Queens, NY
| | - Jerry Liu
- Icahn School of Medicine, New York, NY
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Dridi M, Bouleftour W, Rivoirard R, Dal Col P, Langrand-Escure J, Vassal C, Guillot A. Leptomeningeal Metastases in Renal Cell Carcinoma at Initial Diagnosis: 2 Case Reports and Literature Review. Cancer Invest 2019; 37:501-505. [PMID: 31583922 DOI: 10.1080/07357907.2019.1662031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Leptomeningeal metastasis (LM) in solid tumors are rare, even more in renal cell carcinoma (RCC). To date there is a lack of consensual treatment modalities of leptomeningeal metastasis. Furthermore, with the improvement of outcomes and more effective systemic targeted therapies, the management of leptomeningeal metastasis becomes a real challenge. We here report two cases of RCC with leptomeningeal metastasis at initial diagnosis. Both patients had concurrent adjacent skull bone metastasis. Therapeutic management of both patients consisted in surgical resection, followed by radiotherapy in one case. Systemic treatment was delayed according to current recommendations for the management of metastatic RCC. The aim of this work is to report the therapeutic approach and related outcomes and also provide a review of the currently available literature on leptomeningeal disease in renal cell carcinoma. Indeed, local treatment with curative outcome of meningeal location in RCC should be performed specially in LM at initial diagnosis.
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Affiliation(s)
- Manel Dridi
- Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth , Saint Priest en Jarez , France
| | - Wafa Bouleftour
- Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth , Saint Priest en Jarez , France
| | - Romain Rivoirard
- Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth , Saint Priest en Jarez , France
| | - Pierre Dal Col
- Anatomo-pathology Department, CHU de Saint Etienne , Saint-Etienne , France
| | - Julien Langrand-Escure
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth , Saint Priest en Jarez , France
| | - Cécile Vassal
- Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth , Saint Priest en Jarez , France
| | - Aline Guillot
- Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth , Saint Priest en Jarez , France
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135
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Chauhan L, Mubarik A, Eddib A, Eid M, Vaziri A, Muddassir S. Complete Eye Ophthalmoplegia: the unusual initial presentation of Leptomeningeal Carcinomatosis. J Community Hosp Intern Med Perspect 2019; 9:355-357. [PMID: 31528289 PMCID: PMC6735305 DOI: 10.1080/20009666.2019.1640016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/28/2019] [Indexed: 11/02/2022] Open
Abstract
Ophthalmoplegia is a paralysis or weakness of extraocular muscles that have a variety of different etiologies including and not limited to Leptomeningeal Carcinomatosis (LC). LC is caused mainly by metastatic cancers and can cause a wide variety of symptoms. We present a case of LC with no preexisting condition who presented with a unilateral ophthalmoplegia as initial presentation who was found to have LC secondary to large B-cell lymphoma.
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Affiliation(s)
- Lakshpaul Chauhan
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Ateeq Mubarik
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Abdulmagid Eddib
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Mohammad Eid
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Ali Vaziri
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Salman Muddassir
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
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136
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Fu JB, Molinares DM, Morishita S, Silver JK, Dibaj SS, Guo Y, Bruera E. Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease. PM R 2019; 12:263-270. [PMID: 31222952 DOI: 10.1002/pmrj.12207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/14/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Evaluate Functional Independence Measure (FIM) changes and incidence of serious medical complications requiring return to the primary acute care service of acute rehabilitation cancer inpatients with leptomeningeal disease (LMD). DESIGN Retrospective chart review. SETTING Tertiary referral based comprehensive cancer center acute inpatient rehabilitation unit. PARTICIPANTS Thirty cancer patients admitted to acute inpatient rehabilitation between 8 January 2014 and 8 August 2018 with pathology confirmed LMD within 6 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM and incidence of return to the primary acute care service. RESULTS Twenty five of 30 (83.3%) patients were noted to have neurologic impairments and 13/30 (43.3%) were noted to have cognitive impairments. Five of 30 patients (16.7%) received intrathecal chemotherapy and 4/30 (13.3%) received radiation during acute inpatient rehabilitation for LMD treatment. Median days in acute care prior to acute inpatient rehabilitation was 22.5. Median days from acute inpatient rehabilitation admission until death of the 23 deceased patients as of 1 January 2019 was 180.00. Twenty of 30 (66.7%) patients were discharged home, 9/30 (30%) transferred to the primary acute care service, and 1/30 (3.3%) discharged to a skilled nursing facility. Reasons for return to the primary acute care service included additional chemotherapy 3/9 (33%), neurologic decline 2/9 (22%), fever 2/9 (22%), altered mental status 1/9 (11%), and progressive polyarthritis 1/9 (11%). Of the 21 patients who completed acute inpatient rehabilitation without return to the primary acute care service, mean FIM subscore changes from admission to discharge for Activities of Daily Living, Mobility, and Motor were 5.1 (P < .001), 4.8 (P < .001) and 11.7 (P < .001), respectively (Wilcoxon signed rank test, significance P < .05). CONCLUSION LMD patients who completed acute inpatient rehabilitation made statistically significant improvements on the majority of FIM items. Most patients were discharged home. Our data suggest LMD should not be a reason for exclusion from acute inpatient rehabilitation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana M Molinares
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA
| | - Seyedeh S Dibaj
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying Guo
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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137
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Abstract
A 65-year-old man, diagnosed with right paranasal sinus neuroendocrine carcinoma with skull base invasion and ipsilateral lymph node involvement underwent chemotherapy. Six months later, the patient underwent radiation therapy for right cervical lymph node recurrence. Two months after the end of the radiation therapy, the patient was referred to our department to perform a whole-body FDG PET for therapeutic assessment. It showed diffuse intense FDG uptake of the whole spinal canal. The physical examination revealed walking disorders. Meningeal contrast enhancement on MRI of the brain and the spinal cord was leading to the diagnosis of carcinomatous meningitis.
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138
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Prabhu RS, Turner BE, Asher AL, Marcrom SR, Fiveash JB, Foreman PM, Press RH, Patel KR, Curran WJ, Breen WG, Brown PD, Jethwa KR, Grills IS, Arden JD, Foster LM, Manning MA, Stern JD, Soltys SG, Burri SH. A multi-institutional analysis of presentation and outcomes for leptomeningeal disease recurrence after surgical resection and radiosurgery for brain metastases. Neuro Oncol 2019; 21:1049-1059. [PMID: 30828727 PMCID: PMC6682204 DOI: 10.1093/neuonc/noz049] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Radiographic leptomeningeal disease (LMD) develops in up to 30% of patients following postoperative stereotactic radiosurgery (SRS) for brain metastases. However, the clinical relevancy of this finding and outcomes after various salvage treatments are not known. METHODS Patients with brain metastases, of which 1 was resected and treated with adjunctive SRS, and who subsequently developed LMD were combined from 7 tertiary care centers. LMD pattern was categorized as nodular (nLMD) or classical ("sugarcoating," cLMD). RESULTS The study cohort was 147 patients. Most patients (60%) were symptomatic at LMD presentation, with cLMD more likely to be symptomatic than nLMD (71% vs. 51%, P = 0.01). Salvage therapy was whole brain radiotherapy (WBRT) alone (47%), SRS (27%), craniospinal radiotherapy (RT) (10%), and other (16%), with 58% receiving a WBRT-containing regimen. WBRT was associated with lower second LMD recurrence compared with focal RT (40% vs 68%, P = 0.02). Patients with nLMD had longer median overall survival (OS) than those with cLMD (8.2 vs 3.3 mo, P < 0.001). On multivariable analysis for OS, pattern of initial LMD (nodular vs classical) was significant, but type of salvage RT (WBRT vs focal) was not. CONCLUSIONS Nodular LMD is a distinct pattern of LMD associated with postoperative SRS that is less likely to be symptomatic and has better OS outcomes than classical "sugarcoating" LMD. Although focal RT demonstrated increased second LMD recurrence compared with WBRT, there was no associated OS detriment. Focal cranial RT for nLMD recurrence after surgery and SRS for brain metastases may be a reasonable alternative to WBRT.
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Affiliation(s)
- Roshan S Prabhu
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
- Southeast Radiation Oncology Group, Charlotte, North Carolina
| | - Brandon E Turner
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Anthony L Asher
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | | | - John B Fiveash
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul M Foreman
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert H Press
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Walter J Curran
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | | | | | | | | | - Lauren M Foster
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | | | - Joseph D Stern
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- Cone Health Cancer Center, Greensboro, North Carolina
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Stuart H Burri
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
- Southeast Radiation Oncology Group, Charlotte, North Carolina
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139
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Wills B, Fan Q, Alexander C, Bailey CR, Gelber AC. Confusion Following Treatment of Ovarian Cancer. Am J Med 2019; 132:e610-e611. [PMID: 30849385 DOI: 10.1016/j.amjmed.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Beatriz Wills
- Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Qihua Fan
- Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Caitlin Alexander
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher R Bailey
- Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan C Gelber
- Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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140
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Brastianos P, Davies MA, Margolin K, Yu HA. Modern Management of Central Nervous System Metastases in the Era of Targeted Therapy and Immune Oncology. Am Soc Clin Oncol Educ Book 2019; 39:e59-e69. [PMID: 31099629 DOI: 10.1200/edbk_241345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Metastases to the central nervous system (CNS) are associated with considerable morbidity and mortality in patients with cancer. Historically, very few systemic therapies have shown efficacy in this patient population. Emerging data are now demonstrating that whole-brain radiation therapy, previously considered the mainstay of treatment of brain metastases, is associated with high rates of neurotoxicity. In this new era of targeted therapy and immunotherapy, clinical outcomes are improving, and patients are living longer. Despite these improvements, there is an urgent need to design central nervous system-penetrant compounds that target the genetic mutations enriched in brain metastases and to bring these to clinical trials.
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Affiliation(s)
- Priscilla Brastianos
- 1 Division of Neuro-Oncology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael A Davies
- 2 Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Kim Margolin
- 3 Department of Medical Oncology, City of Hope, Duarte, CA
| | - Helena A Yu
- 4 Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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141
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Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Okada M. Serum tumor marker levels at the development of intracranial metastasis in patients with lung or breast cancer. J Thorac Dis 2019; 11:1765-1771. [PMID: 31285868 DOI: 10.21037/jtd.2019.05.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Intracranial metastasis (IM) is observed in various cancers, including in lung and breast cancer, and its timely diagnosis is required for successful patient treatment. Various tumor serum markers, such as carcinoembryonic antigen (CEA), pro-gastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), and cancer antigen 15-3 (CA15-3), serve not only as prognostic indicators in lung and breast cancer but also as risk factors for IM development. This study is the first to assess a subgroup of cancer patients with IM that did not show elevated serum tumor marker levels. Methods This retrospective study included 53 patients with lung or breast cancer in which IM was detected by enhanced brain magnetic resonance imaging between January 2013 and December 2018. IM was classified into three types [parenchymal metastasis (PM), leptomeningeal metastasis and dural metastasis]. Serum CEA level was measured using an electrochemiluminescence immunoassay (ECLIA) or chemiluminescent immunoassay. Plasma ProGRP level was measured using a chemiluminescent enzyme immunoassay (CLEIA), and the serum NSE level was measured using ECLIA. The serum CA15-3 level was measured using CLEIA. Univariate and multivariate analyses were performed using Pearson's χ2 test and logistic regression analysis, respectively. Results Among the total 53 patients, 15 patients (28.3%) did not show elevated serum tumor marker levels. Univariate analysis showed that the patients with PM only significantly correlated with no increasing tumor marker level compared with other IM types (P=0.030), as well as female patients and patients without symptoms (P=0.010 and 0.046, respectively). Multivariate showed that the patients with PM only and female patients significantly correlated with no increasing tumor marker level (P=0.038 and 0.014, respectively). Conclusions Our findings describe a subgroup of lung and breast cancer patients with IM that do not show elevated tumor marker levels, indicating the need for the identification of novel indicators for IM or increased monitoring of these patients.
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Affiliation(s)
- Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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142
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Carroll RD, Leigh EC, Curtis Z, Thorpe A, Ballengee J, Pacioles T. A Case of Leptomeningeal Carcinomatosis from Aggressive Metastatic Prostate Cancer. Case Rep Oncol 2019; 12:311-316. [PMID: 31123457 PMCID: PMC6514516 DOI: 10.1159/000499761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/03/2022] Open
Abstract
Leptomeningeal carcinomatosis (LC) is a rare leptomeningeal spread of diffusely metastatic tumors. It occurs more commonly with hematologic tumors, less commonly with solid tumors, and is exceedingly rare in prostate cancer. Due to its scarcity, it has traditionally been difficult to diagnose LC but advancement of MRI has helped considerably. However, even with technological improvements, pre-mortem diagnosis of LC remains difficult and controversial. Our case is a 71-year-old male with prostate cancer with bone metastases who presented to our facility with altered mental status (AMS), lower extremity weakness, and worsening diarrhea. The diarrhea was responsive to antibiotic therapy, but his AMS did not resolve. A head CT without contrast was negative but follow-up brain MRI revealed leptomeningeal enhancement highly suggestive of LC. Cerebrospinal fluid (CSF) cytology results were negative and other CSF studies were inconclusive. Although further studies were planned, the patient continued to deteriorate, and the family elected to withdraw care. He passed away without beginning treatment for the LC. Despite advances in cancer therapies, LC remains difficult to diagnose and treat. Imaging may be suggestive of the condition but the confirmatory tests such as repeated CSF cytology or meningeal biopsy are not only invasive but also usually occur postmortem. Additional methods of CSF testing have been studied to evaluate their role in accurately diagnosing LC but low specificity for LC has somewhat limited their use. Although treatment options are mainly palliative in nature, prompt recognition and early treatment could grant valuable time for patients and families.
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Affiliation(s)
- Ryan David Carroll
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - E Cindy Leigh
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Zachary Curtis
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Anthony Thorpe
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Jason Ballengee
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Toni Pacioles
- Department of Oncology, Marshall University, Huntington, West Virginia, USA
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Kanazawa T, Miwa T, Akiyama T, Ohara K, Kosugi K, Nishimoto M, Yoshida K. A Case of Aggressive Recurrent Intracranial Subdural Hematoma Associated with Angiosarcoma Originating from the Skull. World Neurosurg 2019; 126:120-123. [PMID: 30862578 DOI: 10.1016/j.wneu.2019.02.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Angiosarcoma often arises as a cutaneous disease in the scalp and the face; however, subdural hematoma (SDH) associated with angiosarcoma is extremely rare. CASE DESCRIPTION A 72-year-old woman visited our hospital with gait disorder and progressive consciousness disturbance approximately 3 months after a minor head injury. Initially, on reviewing the results of imaging studies, she was diagnosed with traumatic chronic SDH. Despite repeated operations thereafter, including the embolization of the middle meningeal artery, her general condition progressively worsened, and computed tomography of head repeatedly showed the recurrence of SDH. Based on histopathologic and intraoperative findings, she was finally diagnosed with angiosarcoma originating from the skull. She died shortly thereafter because of aggressive recurrent intracranial SDH caused by leptomeningeal dissemination. CONCLUSIONS In addition to cancers metastatic to the skull or dura mater, angiosarcoma should be included in the differential diagnosis for patients with repeated SDH and bone defect. An effective treatment for angiosarcoma with SDH that shows an unfavorable prognosis has not been established; however, an early diagnosis might be useful for a novel treatment.
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Affiliation(s)
- Tokunori Kanazawa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Ohara
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaaki Nishimoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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El Shafie RA, Böhm K, Weber D, Lang K, Schlaich F, Adeberg S, Paul A, Haefner MF, Katayama S, Hörner-Rieber J, Hoegen P, Löw S, Debus J, Rieken S, Bernhardt D. Palliative Radiotherapy for Leptomeningeal Carcinomatosis-Analysis of Outcome, Prognostic Factors, and Symptom Response. Front Oncol 2019; 8:641. [PMID: 30671384 PMCID: PMC6331444 DOI: 10.3389/fonc.2018.00641] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/06/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: The purpose of this article is to report our institution's 10-year experience on palliative radiotherapy for the treatment of leptomeningeal carcinomatosis (LC), assessing survival, neurologic outcome, and prognostic factors. Patients and methods: We retrospectively analyzed 110 patients who received palliative radiotherapy for LC between 2008 and 2018. The most common histologies were breast cancer (n = 43, 39.1%) and non-small cell lung cancer (NSCLC) (n = 31, 28.2%). Radiotherapy was administered as whole-brain radiotherapy (WBRT) (n = 51, 46.4%), focal spinal RT (n = 11, 10.0%) or both (n = 47, 42.7%). Twenty-five patients (22.7%) were selected for craniospinal irradiation. Clinical performance and neurologic function were quantified on the neurologic function scale (NFS) before and in response to therapy. A Cox Proportional Hazards model with univariate and multivariate analysis was fitted for survival. Results: Ninety-eight patients (89.1%) died and 12 (10.9%) were alive at the time of analysis. Median OS from LC diagnosis and from the beginning of RT was 13.9 weeks (IQR: 7.1-34.0) and 9.9 weeks (IQR: 5.3-26.3), respectively. In univariate analysis, prognostic of longer OS were a Karnofsky performance scale index (KPI) of ≥70% (HR 0.20, 95%-CI: [0.13; 0.32], p < 0.001), initially moderate neurological deficits (NFS ≤2) (HR 0.32, 95% CI: [0.19; 0.52], p < 0.001), symptom response to RT (HR 0.41, 95%-CI: [0.26; 0.67], p < 0.001) and the administration of systemic therapy (HR 0.51, 95%-CI: [0.33; 0.78], p = 0.002). Prognostic of inferior OS were high-grade myelosuppression (HR 1.78, 95% CI: [1.06; 3.00], p = 0.03) and serum LDH levels >500 U/l (HR 3.62, 95% CI: [1.76; 7.44], p < 0.001). Clinical performance, symptom response and serum LDH stayed independently prognostic for survival in multivariate analysis. RT was well-tolerated and except for grade III myelosuppression in 19 cases (17.3%), no high-grade acute toxicities were observed. Neurologic symptom stabilization was achieved in 83 cases (75.5%) and a sizeable improvement in 39 cases (35.5%). Conclusion: Radiotherapy is a well-tolerated and efficacious means of providing symptom palliation for patients with LC, delaying neurologic deterioration while probably not directly influencing survival. Prognostic factors such as clinical performance, neurologic response and serum LDH can be used for patient stratification to facilitate treatment decisions.
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Affiliation(s)
- Rami A. El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Karina Böhm
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Fabian Schlaich
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Angela Paul
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias F. Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Sonja Katayama
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Sarah Löw
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
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145
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Moosavi L, D’Assumpcao C, Bowen J, Heidari A, Cobos E. Leptomeningeal Carcinomatosis From Carcinoma of Unknown Primary in a Young Patient: A Case Report and a Literature Review. J Investig Med High Impact Case Rep 2019; 7:2324709619869380. [PMID: 31423841 PMCID: PMC6699001 DOI: 10.1177/2324709619869380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 11/15/2022] Open
Abstract
Leptomeningeal carcinomatosis, leptomeningeal meningitis, or, as referred here, leptomeningeal metastasis (LM), is a rare but frequently fatal complication seen in advanced stage of cancer either locally advanced or after a metastasis of a known primary cancer. We present a rare and uncommon case of leptomeningeal metastases from carcinoma of unknown primary. A 32-year-old female was diagnosed with LM; however, no known primary carcinoma was identified after 2 separate biopsies. The first biopsy of the right pre-tracheal lymph node showed poorly differentiated pan-keratin (AE1 and AE3) and placental alkaline phosphatase with the possibility of germ cell origin. Second cytology of cervical lymphadenopathy was remarkable for cytokeratin 7 and 20, placental alkaline phosphatase, and CDX2 suggestive of germ line tumor with both mucinous ovarian and gastrointestinal carcinomas. Unfortunately, the LM progressed rapidly despite multiple cycles of germ cell origin directed systemic and intrathecal chemotherapy, and the patient opted for hospice care without getting a chance to identify the primary source.
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146
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Byun YH, Gwak HS, Kwon JW, Kim KG, Shin SH, Lee SH, Yoo H. A Novel Implantable Cerebrospinal Fluid Reservoir : A Pilot Study. J Korean Neurosurg Soc 2018; 61:640-644. [PMID: 30196661 PMCID: PMC6129757 DOI: 10.3340/jkns.2018.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 12/04/2022] Open
Abstract
Objective The purpose of this pilot study was to examine the safety and function of the newly developed cerebrospinal fluid (CSF) reservoir called the V-Port.
Methods The newly developed V-Port consists of a non-collapsible reservoir outlined with a titanium cage and a connector for the ventricular catheter to be assembled. It is designed to be better palpated and more durable to multiple punctures than the Ommaya reservoir. A total of nine patients diagnosed with leptomeningeal carcinomatosis were selected for V-Port insertion. Each patient was followed up for evaluation for a month after the operation.
Results The average operation time for V-Port insertion was 42 minutes and the average incision size was 6.6 cm. The surgical technique of V-Port insertion was found to be intuitive by all neurosurgeons who participated in the pilot study. There was no obstruction or leakage of the V-Port during intrathecal chemotherapy or CSF drainage. Also, there were no complications including post-operative intracerebral hemorrhage, infection and skin problems related to the V-Port.
Conclusion V-Port is a safe and an easy to use implantable CSF reservoir that addresses problems of other implantable CSF reservoirs. Further multicenter clinical trial is needed to prove the safety and the function of the V-Port.
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Affiliation(s)
- Yoon Hwan Byun
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Shin Gwak
- Neuro-Oncology Clinic, Center for Specific Organs Center, National Cancer Center, Goyang, Korea
| | - Ji-Woong Kwon
- Neuro-Oncology Clinic, Center for Specific Organs Center, National Cancer Center, Goyang, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Korea
| | - Sang Hoon Shin
- Neuro-Oncology Clinic, Center for Specific Organs Center, National Cancer Center, Goyang, Korea
| | - Seung Hoon Lee
- Department of Neurosurgery, Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Heon Yoo
- Neuro-Oncology Clinic, Center for Specific Organs Center, National Cancer Center, Goyang, Korea
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147
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Assi HI, Mahmoud T, Saadeh FS, El Darsa H. Management of leptomeningeal metastasis in breast cancer. Clin Neurol Neurosurg 2018; 172:151-159. [PMID: 30015053 DOI: 10.1016/j.clineuro.2018.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/22/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Abstract
Leptomeningeal metastasis (LM), which occurs when malignant cells spread to the central nervous system, is becoming an increasingly common complication in patients with breast cancer. Diagnosis and treatment of LM is challenging. Moreover, prognosis of patients with LM is poor, with a median survival of 6 months after diagnosis. This review highlights the strengths and limitations of currently available diagnostic tools and therapies for LM. The current treatments for LM, including radiotherapy, systemic therapy, and intrathecal treatment, aim to maintain the quality of life of patients by correcting neurological deficits and arresting neurological degeneration. However, there is no standardized therapy for LM because of a lack of randomized trials on this condition.
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Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Lebanon.
| | - Tala Mahmoud
- Faculty of Medicine, University of Balamand, Lebanon.
| | - Fadi S Saadeh
- Faculty of Medicine, American University of Beirut, Lebanon.
| | - Haidar El Darsa
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Lebanon.
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148
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Murakami Y, Ichikawa M, Bakhit M, Jinguji S, Sato T, Fujii M, Sakuma J, Saito K. Palliative shunt surgery for patients with leptomeningeal metastasis. Clin Neurol Neurosurg 2018; 168:175-178. [PMID: 29567579 DOI: 10.1016/j.clineuro.2018.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Leptomeningeal metastasis (LM) is associated with poor prognosis and affects the quality of life (QOL) of end-stage cancer patients. Severe headache associated with hydrocephalus causes reduced QOL. We investigated the clinical value of surgical treatment for hydrocephalus in LM patients. PATIENTS AND METHODS The medical records of 11 consecutive patients who underwent lumboperitoneal shunt (LPS) or ventriculoperitoneal shunt (VPS) at our institution between 2007 and 2016 were investigated. Primary brain tumor patients were excluded. We assessed the neurological status and therapeutic effects at 1 month after the shunt surgery. RESULTS The patients were three males and eight females with a median age of 58 years (interquartile range [IR] 52-68 years). The median preoperative neutrophil-to-lymphocyte ratio was 6.4 (IR 4.8-9.2). Symptom improvement was observed in nine patients, and severe headache was relieved in seven (88%) out of eight patients. The median Karnofsky performance status scale increased from 40 to 60, and the median overall survival after primary malignancy diagnosis was 27.4 months (IR 19.6-63.1 months). The median survival after the diagnosis of brain parenchymal metastasis, LM, and shunt surgery were 7.2 months (IR 5.1-14.1 months), 3.9 months (IR 3.5-6.3 months), and 3.3 months (IR 2.9-5.7 months), respectively. CONCLUSION Shunt surgery for hydrocephalus could offer an effective palliative surgical option for symptom relief especially relief of severe headache, contributing improvement of QOL in LM patients.
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Affiliation(s)
- Yuta Murakami
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Masahiro Ichikawa
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Mudathir Bakhit
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Shinya Jinguji
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Taku Sato
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Jun Sakuma
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan.
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