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Kumar A, Sardhara JC, Singh G, Kanjilal S, Maurya VP, Behari S. Malignant Meningitis Associated with Hydrocephalus. Neurol India 2021; 69:S443-S455. [PMID: 35103001 DOI: 10.4103/0028-3886.332278] [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] [Indexed: 02/03/2023]
Abstract
Malignant meningitis (MM) is the diffuse involvement of the leptomeninges by infiltrating cancer cells, most frequently from lung and breast cancers. This review is aimed to discuss the current advances in the diagnosis and management of MM, along with management of MM-associated hydrocephalus. We reviewed the literature using PubMed and Google Scholar search engines, focusing on various recent randomized controlled trials and clinical trials on MM. Given the hallmark multifocal involvement, the clinical symptoms and signs are also random and asymmetric. There are three important pillars for establishing a diagnosis of MM: clinical examination, neuroimaging, and CSF cytological findings. Several factors should be considered in decision-making, including performance status, neurological findings (clinical, MRI, and CSF flow dynamic), and evaluation of the primary tumor (nature and systemic dissemination). Response Assessment in Neuro-Oncology (RANO) working group recommended the objective assessment of disease for evaluating the progression and response to therapy. Pillars of current management are mainly focal irradiation and intrathecal or systemic chemotherapy. Symptomatic hydrocephalus is managed with a ventriculoperitoneal shunt, lumboperitoneal shunt, or endoscopic third ventriculostomy as palliative procedures, providing significant improvement in performance scores in the limited survival time of patients with MM. Studies using novel therapeutic approaches, such as new biological or cytotoxic compounds, are ongoing. Despite the use of all the combinations, the overall prognosis remains grim; therefore, decision-making for treatment should predominantly be based on attaining an optimal quality of life.
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Affiliation(s)
- Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh C Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Guramritpal Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ved P Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ansari KI, Bhan A, Saotome M, Tyagi A, De Kumar B, Chen C, Takaku M, Jandial R. Autocrine GM-CSF signaling contributes to growth of HER2+ breast leptomeningeal carcinomatosis. Cancer Res 2021; 81:4723-4735. [PMID: 34247146 DOI: 10.1158/0008-5472.can-21-0259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/29/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
Leptomeningeal carcinomatosis (LC) occurs when tumor cells spread to the cerebrospinal fluid-containing leptomeninges surrounding the brain and spinal cord. LC is an ominous complication of cancer with a dire prognosis. Although any malignancy can spread to the leptomeninges, breast cancer, particularly the HER2+ subtype, is its most common origin. HER2+ breast LC (HER2+ LC) remains incurable, with few treatment options, and the molecular mechanisms underlying proliferation of HER2+ breast cancer cells in the acellular, protein, and cytokine-poor leptomeningeal environment remain elusive. Therefore, we sought to characterize signaling pathways that drive HER2+ LC development as well as those that restrict its growth to leptomeninges. Primary HER2+ LC patient-derived ("Lepto") cell lines in co-culture with various central nervous system (CNS) cell types revealed that oligodendrocyte progenitor cells (OPC), the largest population of dividing cells in the CNS, inhibited HER2+ LC growth in vitro and in vivo, thereby limiting the spread of HER2+ LC beyond the leptomeninges. Cytokine array-based analyses identified Lepto cell-secreted granulocyte-macrophage colony-stimulating factor (GM-CSF) as an oncogenic autocrine driver of HER2+ LC growth. Liquid chromatography-tandem mass spectrometry-based analyses revealed that the OPC-derived protein TPP1 proteolytically degrades GM-CSF, decreasing GM-CSF signaling and leading to suppression of HER2+ LC growth and limiting its spread. Lastly, intrathecal delivery of neutralizing anti-GM-CSF antibodies and a pan-Aurora kinase inhibitor (CCT137690) synergistically inhibited GM-CSF and suppressed activity of GM-CSF effectors, reducing HER2+ LC growth in vivo. Thus, OPC suppress GM-CSF-driven growth of HER2+ LC in the leptomeningeal environment, providing a potential targetable axis.
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Tasaki K, Terada A, Nishida N, Murakami F. Carcinomatous meningitis from recurrent glassy cell carcinoma of the uterine cervix-A case report. J Obstet Gynaecol Res 2021; 47:3396-3400. [PMID: 34128292 DOI: 10.1111/jog.14885] [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: 02/22/2021] [Revised: 05/10/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
Carcinomatous meningitis presents with a variety of neurological symptoms and has a poor prognosis. We encountered a case of carcinomatous meningitis from cervical cancer. A 30-year-old patient was diagnosed with cervical cancer (glassy cell carcinoma), stage IIB. She underwent radical hysterectomy and chemoradiotherapy. Nine months later, the disease recurred with iliac lymph node and right lung metastases. The patient received chemotherapy; however, after seven cycles, the lung lesions increased. The patient responded to supportive care; nevertheless, symptoms including headaches developed and were followed by diplopia. A contrast-enhanced magnetic resonance image of the head confirmed the diagnosis of carcinomatous meningitis. She was transferred to the palliative care unit and died approximately 1 week later. Carcinomatous meningitis has a poor prognosis and is difficult to treat; however, early diagnosis may provide meaningful time to patients. Therefore, attention must be paid to meningeal irritation and neurological symptoms.
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Affiliation(s)
- Kazuto Tasaki
- Department of Obstetrics and Gynecology, St. Mary's Hospital, Kurume, Japan
| | - Atsumu Terada
- Department of Obstetrics and Gynecology, St. Mary's Hospital, Kurume, Japan
| | - Naoyo Nishida
- Department of Pathology, St. Mary's Hospital, Kurume, Japan
| | - Fumihiro Murakami
- Department of Obstetrics and Gynecology, St. Mary's Hospital, Kurume, Japan
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Debnam JM, Said RB, Liu HH, Sun J, Wang J, Wei W, Suki D, Mayer RR, Chi TL, Ketonen L, Guha-Thakurta N, Weinberg JS. Ventricular apparent diffusion coefficient measurements in patients with neoplastic leptomeningeal disease. Cancer Imaging 2020; 20:41. [PMID: 32600415 PMCID: PMC7322838 DOI: 10.1186/s40644-020-00305-2] [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: 12/02/2019] [Accepted: 04/01/2020] [Indexed: 12/05/2022] Open
Abstract
Background To test the hypothesis that intraventricular ADC values can be used to determine the presence of neoplastic leptomeningeal disease (LMD). Materials and methods ADC values were measured at multiple sites in the ventricular system in 32 patients with cytologically-proven LMD and 40 control subjects. Multiple linear regression analysis was used to determine the mean difference of ADCs between the LMD and control groups after adjusting for ventricle size and tumor type. Receiver operating characteristics (ROC) analysis was performed and optimal ADC value cut-off point for predicting the presence of LMD. ADC was compared to T1 enhancement and FLAIR signal hyperintensity for determining the presence of LMD. Results After adjusting for ventricular volume and tumor type, the mid body of lateral ventricles showed no significant difference in ventricular volume and a significant difference in ADC values between the control and LMD groups (p > 0.05). In the mid-body of the right lateral ventricle the AUC was 0.69 (95% CI 0.57–0.81) with an optimal ADC cut off point of 3.22 × 10− 9 m2/s (sensitivity, specificity; 0.72, 0.68). In the mid-body of left lateral ventricle the AUC was 0.7 (95% CI 0.58–0.82) with an optimal cut-off point of 3.23 × 10− 9 m2/s (0.81, 0.62). Using an average value of HU measurements in the lateral ventricles the AUC was 0.73 (95% CI 0.61–0.84) with an optimal cut off point was 3.11 × 10− 9 m2/s (0.78, 0.65). Compared to the T1 post-contrast series, ADC was predictive of the presence of LMD in the mid-body of the left lateral ventricle (p = 0.036). Conclusion Complex interactions affect ADC measurements in patients with LMD. ADC values in the lateral ventricles may provide non-invasive clues to the presence of LMD.
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Affiliation(s)
- James M Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA.
| | - Ryan B Said
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA
| | - Heng-Hsiao Liu
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rory R Mayer
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - T Linda Chi
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA
| | - Leena Ketonen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA
| | - Nandita Guha-Thakurta
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kumthekar P, Tang SC, Brenner AJ, Kesari S, Piccioni DE, Anders C, Carrillo J, Chalasani P, Kabos P, Puhalla S, Tkaczuk K, Garcia AA, Ahluwalia MS, Wefel JS, Lakhani N, Ibrahim N. ANG1005, a Brain-Penetrating Peptide-Drug Conjugate, Shows Activity in Patients with Breast Cancer with Leptomeningeal Carcinomatosis and Recurrent Brain Metastases. Clin Cancer Res 2020; 26:2789-2799. [PMID: 31969331 DOI: 10.1158/1078-0432.ccr-19-3258] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE ANG1005, a novel taxane derivative, consists of three paclitaxel molecules covalently linked to Angiopep-2, designed to cross the blood-brain and blood-cerebrospinal barriers and to penetrate malignant cells via LRP1 transport system. Preclinical and clinical evidence of efficacy with ANG1005 has been previously shown. PATIENTS AND METHODS A multicenter, open-label phase II study in adult patients with measurable recurrent brain metastases from breast cancer (BCBM), with or without leptomeningeal carcinomatosis was conducted (n = 72 BCBM; n = 28 leptomeningeal carcinomatosis subset). ANG1005 was administered intravenously at 600 mg/m2 every 3 weeks. Tumor assessment was based on central nervous system (CNS) RECIST 1.1 for intracranial, and RECIST 1.1 for extracranial response. The primary endpoint was determination of intracranial objective response rate (iORR). RESULTS Median age was 47.5 years. Safety profile was similar to that of paclitaxel with myelosuppression as the predominating toxicity. Average number of prior CNS-directed therapies was 2.8 and 94% of the patients had prior taxane treatment. Patient benefit (stable disease or better) was seen in 77% (intracranial) and 86% (extracranial) of the evaluable patients, with iORR of 15% (investigator) or 8% (independent radiology facility [IRF] review). In the leptomeningeal carcinomatosis subset, 79% of the patients had intracranial disease control and estimated median overall survival of 8.0 months (95% CI, 5.4-9.4). CONCLUSIONS Even though the study preset rule for iORR per IRF was not met in this heavily pretreated population, a notable CNS and systemic treatment effect was seen in all patients including symptom improvement and prolonged overall survival compared to historical control for the subset of patients with leptomeningeal carcinomatosis (n = 28).
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Affiliation(s)
- Priya Kumthekar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Shou-Ching Tang
- Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Santosh Kesari
- John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, California
| | - David E Piccioni
- Department of Neurosciences, UC San Diego Moores Cancer Center, La Jolla, California
| | | | - Jose Carrillo
- John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
| | | | - Peter Kabos
- University of Colorado, Anschutz Medical Campus, Greenwood Village, Colorado
| | - Shannon Puhalla
- University of Pittsburgh Magee Women's Cancer Program, Pittsburgh, Pennsylvania
| | - Katherine Tkaczuk
- University Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Manmeet S Ahluwalia
- Miller Family Endowed Chair in NeuroOncology; Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nehal Lakhani
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, Michigan
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center; Houston, Texas
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Lamba N, Fick T, Nandoe Tewarie R, Broekman ML. Management of hydrocephalus in patients with leptomeningeal metastases: an ethical approach to decision-making. J Neurooncol 2018; 140:5-13. [PMID: 30022283 PMCID: PMC6182391 DOI: 10.1007/s11060-018-2949-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Leptomeningeal metastases (LM) are a rare, but often debilitating complication of advanced cancer that can severely impact a patient's quality-of-life. LM can result in hydrocephalus (HC) and lead to a range of neurologic sequelae, including weakness, headaches, and altered mental status. Given that patients with LM generally have quite poor prognoses, the decision of how to manage this HC remains unclear and is not only a medical, but also an ethical one. METHODS We first provide a brief overview of management options for hydrocephalus secondary to LM. We then apply general ethical principles to decision making in LM-associated hydrocephalus that can help guide physicians and patients. RESULTS Management options for LM-associated hydrocephalus include shunt placement, repeated lumbar punctures, intraventricular reservoir placement, endoscopic third ventriculostomy, or pain management alone without intervention. While these options may offer symptomatic relief in the short-term, each is also associated with risks to the patient. Moreover, data on survival and quality-of-life following intervention is sparse. We propose that the pros and cons of each option should be evaluated not only from a clinical standpoint, but also within a larger framework that incorporates ethical principles and individual patient values. CONCLUSIONS The decision of how to manage LM-associated hydrocephalus is complex and requires close collaboration amongst the physician, patient, and/or patient's family/friends/community leaders. Ultimately, the decision should be rooted in the patients' values and should aim to optimize a patient's quality-of-life.
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Affiliation(s)
- Nayan Lamba
- Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tim Fick
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marike L Broekman
- Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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7
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Abstract
Patients with cancer experience many acute and chronic pain syndromes, the identification of which may be helpful in the assessment and treatment of pain. Syndromes are defined by the relationship with the cancer, the pain pathophysiology, and the clinical characteristics of the pain. The most common pain syndromes are directly related to the tumor; bone pain syndromes are most common. Neuropathic pain syndromes may involve cancer-related injury at any level of the peripheral nervous system. Treatment-related pain syndromes may follow any type of antineoplastic therapy. This article reviews the phenomenology of common acute and chronic cancer pain syndromes.
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Affiliation(s)
- Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA.
| | - Ebtesam Ahmed
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
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8
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Stone M. Leptomeningeal Carcinomatosis: Cerebral spinal fluid tumours. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2018. [DOI: 10.21307/ajon-2017-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Moyo N. Does duration and sampling of external ventricular drainage systems influence infection rate? AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2018. [DOI: 10.21307/ajon-2017-127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Galicia N, Dégano R, Díez P, González-González M, Góngora R, Ibarrola N, Fuentes M. CSF analysis for protein biomarker identification in patients with leptomeningeal metastases from CNS lymphoma. Expert Rev Proteomics 2017; 14:363-372. [DOI: 10.1080/14789450.2017.1307106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- N. Galicia
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - R. Dégano
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - P. Díez
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - M. González-González
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - R. Góngora
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - N. Ibarrola
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - M. Fuentes
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
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11
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Yamashiro S, Hitoshi Y, Tajiri S, Uchikawa H, Ito K, Yoshida A, Kuratsu JI. Palliative lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus: A case series. Palliat Med 2017; 31:93-96. [PMID: 27188875 DOI: 10.1177/0269216316649128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Leptomeningeal metastasis-related hydrocephalus causes distress to patients with end-stage cancer through headache and other symptoms by elevating intracranial pressure, thus reducing quality of life. Ventriculoperitoneal shunt has been used as a treatment option in palliative care. We review four cases of patients who underwent lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus. CASES All patients suffered from severe headache and nausea. The primary lesion was histologically diagnosed as lung adenocarcinoma in each case. The duration from diagnosis to onset of hydrocephalus symptoms ranged from 0 to 52 (mean 26) months. Cerebrospinal fluid pressure in every case was above the normal range due to high intracranial pressure. Case management: Conventional procedures for lumboperitoneal shunt were employed for all patients. Adjustable pressure valves were retrofitted into the shunt system. Case outcome: Three patients demonstrated significant improvement of clinical symptoms and quality of life after placement of lumboperitoneal shunts. In two cases, not only did performance status improve to independent daily activity but also comparatively long-term survival was achieved due to subsequent chemotherapies after surgery. No symptoms of peritoneal dissemination by floating cancer cells in cerebrospinal fluid were seen in any patients. CONCLUSION Lumboperitoneal shunt appears to improve quality of life if the patient is suffering from symptoms of leptomeningeal metastasis-related hydrocephalus. Compared to ventriculoperitoneal shunt, lumboperitoneal shunt is less invasive and simpler, providing a suitable option for frail patients with end-stage cancer. Adjustable pressure shunt valves can cope with varying symptoms and ventricle sizes.
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Affiliation(s)
- Shigeo Yamashiro
- 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Yasuyuki Hitoshi
- 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Seiji Tajiri
- 2 Department of Neurosurgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Hiroki Uchikawa
- 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Kiyotaka Ito
- 3 Department of Internal Medicine, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Akimasa Yoshida
- 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Jun-Ichi Kuratsu
- 4 Department of Neurosurgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Proteomic Biomarker Identification in Cerebrospinal Fluid for Leptomeningeal Metastases with Neurological Complications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 974:85-96. [PMID: 28353226 DOI: 10.1007/978-3-319-52479-5_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Leptomeningeal metastases (LM) from solid tumours, lymphoma and leukaemia are characterized by multifocal neurological deficits with a high mortality rate. Early diagnosis and initiation of treatment are essential to kerb neurological deterioration. However, this is not always possible as 25% of cerebrospinal fluid samples produce false-negative results at first cytological examination. The identification of biomarkers that allow stratification of individuals according to risk for developing LM would be a major benefit. Proteomic-based approaches are now in increasing use for this purpose, and these are reviewed in this chapter with a focus on cerebrospinal fluid (CSF) analyses. The construction of a CSF proteome disease database would also facilitate analysis of other neurological disorders.
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13
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Lin DM, Park JW, Gattuso P. Metastatic Signet-Ring Cell Carcinoma of the Bladder in Cerebrospinal Fluid. Diagn Cytopathol 2016; 45:73-76. [PMID: 27629260 DOI: 10.1002/dc.23603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/06/2016] [Accepted: 08/22/2016] [Indexed: 11/09/2022]
Abstract
Primary bladder signet-ring cell carcinoma (SRCC) is extremely rare and associated with an aggressive course. To our knowledge, we describe the first metastatic bladder SRCC identified in cerebrospinal fluid (CSF). A 68-year-old male with 1 year history of primary bladder SRCC with spinal metastasis presented with multiple falls and loss of consciousness. Brain imaging showed high signal in the frontoparietal sulci and superior cerebellum. CSF analysis was significant for increased leukocytes with monocyte predominance while protein and glucose values were within normal range. There was a hypercellular population of pleomorphic tumor cells with signet-ring morphology, similar to those seen in his diagnostic bladder biopsies. The signet-ring cells were positive for cytokeratin 7 and 20 and negative for CDX-2 and prostate-specific antigen. The patient's clinical condition rapidly deteriorated and he died less than a week after presentation. At autopsy, brain sections revealed signet ring cells in the meninges overlying the cerebrum, cerebellum, brainstem, spinal cord, and pituitary with superficial invasion of the brain parenchyma. No brain parenchymal lesions were present. This case illustrates a unique complication of primary bladder SRCC. Diagn. Cytopathol. 2017;45:73-76. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Diana Murro Lin
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Ji-Weon Park
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
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14
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Perillyl Alcohol and Its Drug-Conjugated Derivatives as Potential Novel Methods of Treating Brain Metastases. Int J Mol Sci 2016; 17:ijms17091463. [PMID: 27598140 PMCID: PMC5037741 DOI: 10.3390/ijms17091463] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 12/02/2022] Open
Abstract
Metastasis to the central nervous system remains difficult to treat, and such patients are faced with a dismal prognosis. The blood-brain barrier (BBB), despite being partially compromised within malignant lesions in the brain, still retains much of its barrier function and prevents most chemotherapeutic agents from effectively reaching the tumor cells. Here, we review some of the recent developments aimed at overcoming this obstacle in order to more effectively deliver chemotherapeutic agents to the intracranial tumor site. These advances include intranasal delivery to achieve direct nose-to-brain transport of anticancer agents and covalent modification of existing drugs to support enhanced penetration of the BBB. In both of these areas, use of the natural product perillyl alcohol, a monoterpene with anticancer properties, contributed to promising new results, which will be discussed here.
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15
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Detection of Leptomeningeal Involvement by 18F-FDG-PET/CT in a Patient With Non-Hodgkin Lymphoma. Clin Nucl Med 2016; 41:169-72. [PMID: 26545028 DOI: 10.1097/rlu.0000000000001060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leptomeningeal infiltration of the brain or spinal cord by neoplastic cells may occur as complication of solid or hematopoietic tumors such as non-Hodgkin lymphoma. Previously rare, this event is becoming increasingly common as newer therapies can prolong survival but may not achieve therapeutic concentration in the central nervous system. Although prognosis is poor, early diagnosis and aggressive treatment may lead to prolonged survival and/or improvement of quality of life. We report a case of a 69-year-old man with leptomeningeal infiltration by non-Hodgkin lymphoma revealed by F-FDG-PET/CT and confirmed by subsequent spinal MRI and cerebrospinal fluid cytology.
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Milojkovic Kerklaan B, Pluim D, Bol M, Hofland I, Westerga J, van Tinteren H, Beijnen JH, Boogerd W, Schellens JHM, Brandsma D. EpCAM-based flow cytometry in cerebrospinal fluid greatly improves diagnostic accuracy of leptomeningeal metastases from epithelial tumors. Neuro Oncol 2015; 18:855-62. [PMID: 26566655 DOI: 10.1093/neuonc/nov273] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Moderate diagnostic accuracy of MRI and initial cerebrospinal fluid (CSF) cytology analysis results in at least 10%-15% false negative diagnoses of leptomeningeal metastases (LM) of solid tumors, thus postponing start of therapy. The aim of this prospective clinical study was to determine the diagnostic value of epithelial cell adhesion molecule (EpCAM)-based flow cytometry versus cytology in CSF for the diagnosis of LM in patients with epithelial tumors. METHODS Patients with a clinical suspicion of LM but a negative or inconclusive MRI in whom a diagnostic lumbar puncture has to be performed were included. At least 5 mL of CSF for cytology, 5 mL for flow cytometry, 2 mL for cell count and biochemistry, and 8 mL whole blood samples for circulating tumor cells measurements and biochemistry were drawn. Tumor cells in CSF and whole blood were detected by multiparameter flow cytometry using EpCAM antibody. RESULTS In total 29 eligible patients were enrolled in the study. Thirteen patients were ultimately diagnosed with LM. The flow cytometry assay showed 100% sensitivity and 100% specificity for diagnosing LM, while sensitivity of CSF cytology was only 61.5%. Cell count or biochemical parameters in CSF were abnormal in 100% of patients with LM. CONCLUSIONS Our results suggest that the EpCAM-based flow cytometry assay is superior to CSF cytology for the diagnosis of LM in patients with an epithelial tumor, a clinical suspicion of LM, and a nonconclusive MRI. Confirmation of these data is needed in a larger dataset to recommend dual CSF diagnostics for LM. CLINICALTRIALSGOV IDENTIFIER NCT01713699.
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Affiliation(s)
- Bojana Milojkovic Kerklaan
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Dick Pluim
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Mijke Bol
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Ingrid Hofland
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Johan Westerga
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Harm van Tinteren
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Jos H Beijnen
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Willem Boogerd
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Jan H M Schellens
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
| | - Dieta Brandsma
- Department of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands (B.M.K., D.P., I.H., J.H.M.S.); Department of Clinical Pharmacology, NKI-AVL, Amsterdam, the Netherlands (B.M.K., J.H.M.S.); Department of Pathology, NKI-AVL, Amsterdam, the Netherlands (M.B.), Core Facility Molecular Pathology & Biobanking (CFMPB), Department of Molecular Pathology, NKI-AVL, Amsterdam, the Netherlands (I.H.); Department of Pathology, Slotervaart Hospital, Amsterdam, the Netherlands (J.W.); Biometric Department, NKI-AVL, Amsterdam, the Netherlands (H.v.T.); Department of Pharmacy and Pharmacology, NKI-AVL, Amsterdam, the Netherlands (J.H.B.); Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands (J.H.B., J.H.M.S.); Department of Neuro-oncology, NKI-AVL, Amsterdam, the Netherlands (W.B., D.B.)
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Chen TC, Napolitano GR, Adell F, Schönthal AH, Shachar Y. Development of the Metronomic Biofeedback Pump for leptomeningeal carcinomatosis: technical note. J Neurosurg 2015; 123:362-72. [DOI: 10.3171/2014.10.jns14343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with leptomeningeal carcinomatosis face a particularly grim prognosis. Current treatment consists of intrathecal delivery of methotrexate (MTX) or cytosine arabinoside (Ara-C) via Ommaya reservoir or lumbar puncture. Yet despite these interventions, the median survival after diagnosis is only 4–7 months. To address inherent shortcomings of current treatments and provide a more effective therapeutic approach, the Pharmaco-Kinesis Corporation has developed a novel type of implantable pump capable of delivering intrathecal chemotherapy (i.e., MTX) in a metronomic fashion with electronic feedback. The Metronomic Biofeedback Pump (MBP) consists of 3 components: 1) a 2-lumen catheter; 2) a microfluidic delivery pump with 2 reservoirs; and 3) a spectrophotometer monitoring MTX concentrations in the CSF. Using an animal model of intraventricular drug delivery, the authors demonstrate that the MBP can reliably deliver volumes of 500 μl/min, consistently measure real-time intrathecal MTX concentrations via CSF aspiration, and provide biofeedback with the possibility of instant control and delivery adjustments. Therefore, this novel approach to chemotherapy minimizes toxic drug levels and ensures continuous exposure at precisely adjusted, individualized therapeutic levels. Altogether, application of the MBP is expected to increase survival of patients with leptomeningeal carcinomatosis, and appropriate Phase I and II trials are pending.
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Affiliation(s)
| | | | - Frank Adell
- 2Pharmaco-Kinesis Corporation, Inglewood; and
| | - Axel H. Schönthal
- 3Molecular Microbiology & Immunology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Yehoshua Shachar
- 2Pharmaco-Kinesis Corporation, Inglewood; and
- 4Magnetecs Corporation, Inglewood, California
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Chilkulwar A, Pottimutyapu R, Wu F, Padooru KR, Pingali SR, Kassem M. Leptomeningeal carcinomatosis associated with papillary renal cell carcinoma. Ecancermedicalscience 2014; 8:468. [PMID: 25374616 PMCID: PMC4203475 DOI: 10.3332/ecancer.2014.468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Indexed: 12/30/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC), or neoplastic meningitis, occurs in about 5–20% of patients with metastatic cancer, depending on the type of the primary malignancy and kind of treatment received. The association of LMC with renal cell carcinoma (RCC) is a rare entity, and only two cases of papillary renal cell cancer with leptomeningeal metastasis have been reported. Leptomeningeal spread usually confers a poor prognosis despite the use of modern treatment strategies as compared to patients with extracranial metastases. We report a case of papillary RCC, a less common type of RCC presenting with LMC.
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Affiliation(s)
- Abhishek Chilkulwar
- Department of Haematology and Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Ramya Pottimutyapu
- Department of Internal Medicine, Mount Sinai Hospital Medical Centre, Chicago, Illinois 60608, USA
| | - Fawng Wu
- Department of Internal Medicine, Mount Sinai Hospital Medical Centre, Chicago, Illinois 60608, USA
| | - Keerthi R Padooru
- Department of Medicine, S.V.S Medical College, Mahbub Nagar, Telangana 509001, India
| | - Sai Ravi Pingali
- Houston Methodist Cancer Centre, 6445 Main St, Houston, TX 77030, USA
| | - Mohammed Kassem
- Department of Internal Medicine, Mount Sinai Hospital Medical Centre, Chicago, Illinois 60608, USA
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19
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Scott BJ, van Vugt VA, Rush T, Brown T, Chen CC, Carter BS, Schwab R, Fanta P, Helsten T, Bazhenova L, Parker B, Pingle S, Saria MG, Brown BD, Piccioni DE, Kesari S. Concurrent intrathecal methotrexate and liposomal cytarabine for leptomeningeal metastasis from solid tumors: a retrospective cohort study. J Neurooncol 2014; 119:361-8. [PMID: 24942463 DOI: 10.1007/s11060-014-1486-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 05/19/2014] [Indexed: 12/15/2022]
Abstract
Leptomeningeal metastasis (LM) from solid tumors is typically a late manifestation of systemic cancer with limited survival. Randomized trials comparing single agent intrathecal methotrexate to liposomal cytarabine have shown similar efficacy and tolerability. We hypothesized that combination intrathecal chemotherapy would be a safe and tolerable option in solid tumor LM. We conducted a retrospective cohort study of combination IT chemotherapy in solid tumor LM at a single institution between April 2010 and July 2012. In addition to therapies directed at active systemic disease, each subject received IT liposomal cytarabine plus IT methotrexate with dexamethasone premedication. Patient characteristics, survival outcomes and toxicities were determined by systematic chart review. Thirty subjects were treated during the study period. The most common cancer types were breast 15 (50 %), glioblastoma 6 (20 %), and lung 5 (17 %). Cytologic clearance was achieved in 6 (33 %). Median non-glioblastoma overall survival was 30.2 weeks (n = 18; range 3.9-73.4), and did not differ significantly by tumor type. Median time to neurologic progression was 7 weeks (n = 8; range 0.9-57), with 10 subjects (56 %) experiencing death from systemic disease without progression of LM. Age less than 60 was associated with longer overall survival (p = 0.01). Six (21 %) experienced grade III toxicities during treatment, most commonly meningitis 2 (7 %). Combination IT chemotherapy was feasible in this small retrospective cohort. Prospective evaluation is necessary to determine tolerability, the impact on quality of life and neurocognitive outcomes or any survival benefit when compared to single agent IT chemotherapy.
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Affiliation(s)
- Brian J Scott
- Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA,
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Kim NH, Kim JH, Chin HM, Jun KH. Leptomeningeal carcinomatosis from gastric cancer: single institute retrospective analysis of 9 cases. Ann Surg Treat Res 2014; 86:16-21. [PMID: 24761402 PMCID: PMC3994606 DOI: 10.4174/astr.2014.86.1.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the clinical features and outcomes of 9 consecutive patients who suffered with leptomeningeal carcinomatosis (LMC) originating from gastric cancer. METHODS Between January 1995 and December 2010, we retrospectively reviewed the medical records of 9 patients with gastric LMC who had been treated at St. Vincent's Hospital, The Catholic University of Korea. RESULTS With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 5 cases had poorly differentiated or signet ring cell histology. TNM stage of the primary gastric cancer was III in 6 patients. The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 9 months. Headache (6 cases), altered mental status (4 cases), and dysarthria (3 cases) were presenting symptoms of LMC. Computed tomography findings were abnormal in 4 of 7 cases, while magnetic resonance imaging revealed abnormality in 4 of 5 cases. Radiation therapy was administered to 5 patients and intrathecal chemotherapy was administered to only 1 patient. Median overall survival duration from the diagnosis of LMC was 3 months. CONCLUSION LMC originating from gastric cancer had a fatal clinical course and treatment strategies remain challenging.
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Affiliation(s)
- Nam-Hee Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Ji-Hyun Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hyung-Min Chin
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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Wauters CAP, Poelen J, Mulder I, Venderink D, Strobbe LJA, Wesseling P. Contribution of CSF cytology in the diagnostic work-up of breast cancer patients with neurological symptoms: a retrospective analysis over two decades. J Neurooncol 2012; 107:581-9. [PMID: 22215233 DOI: 10.1007/s11060-011-0782-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the contribution of cytological analysis of cerebrospinal fluid (CSF) in the diagnostic work-up of breast cancer patients who present with neurological symptoms suspected for central nervous system (CNS) metastases. In the period 1989-2009, a total of 81 patients with breast cancer underwent CSF cytological examination. Relevant tumour characteristics, clinical presentation and radiological findings were scored. The CSF cytological diagnosis was classified according to the 1996 NCI-sponsored conference approach as malignant, suspicious for malignancy, atypical, benign or inadequate. During the course of 20 years, 145 CSF cytological examinations were performed. Relatively common neurological symptoms resulting in cytological CSF examination were headache (n = 25), nausea and vomiting (n = 19), sensory disturbances (n = 16), and cranial nerve dysfunction (n = 16). Of these, headache and nausea/vomiting were most often associated with malignant cells in the CSF (CSF(+)) (in 48 and 53% of the cases, respectively). The 4 patients with both headache and confusion/altered mental status all had CSF(+). In 10 patients, CSF(+) was found despite the absence of radiological evidence for metastasis in/around the CNS. In our series, repeated CSF analysis appeared to have limited additional value, and CSF(+) was strongly correlated with shorter survival. A substantial number of patients with neurological symptoms but without radiological abnormalities can have CSF(+). In our series, the additional value of repeated cytological examination of CSF was limited. Our study underscores the value of CSF cytology as a tool for the unequivocal diagnosis of metastatic spread of breast cancer to the CNS, and confirms that CSF(+) is a strong predictor of poor survival.
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Affiliation(s)
- C A P Wauters
- Department of Pathology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
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Van Horn A, Chamberlain MC. Neoplastic meningitis. ACTA ACUST UNITED AC 2011; 10:45-53. [PMID: 22005214 DOI: 10.1016/j.suponc.2011.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/02/2011] [Indexed: 02/06/2023]
Abstract
Neoplastic meningitis occurs in approximately 5%-10% of all patients with cancer, and aggressive supportive measures are a critical component of comprehensive care. A literature review of the current diagnostic methods, randomized controlled trials, and available treatments was undertaken; and a comprehensive discussion of best-practice supportive care measures is provided. Although the prognosis for those diagnosed with neoplastic meningitis is poor, treatment and supportive care may allow stabilization of neurologic symptoms and afford protection from further neurologic deterioration, allowing patients to maximize their function and independence and adjust their expectations of treatment from cure to palliation.
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Affiliation(s)
- Alixis Van Horn
- Department of Neurology and Neurological Surgery, University of Washington, Seattle, WA, USA
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Lin N, Dunn IF, Glantz M, Allison DL, Jensen R, Johnson MD, Friedlander RM, Kesari S. Benefit of ventriculoperitoneal cerebrospinal fluid shunting and intrathecal chemotherapy in neoplastic meningitis: a retrospective, case-controlled study. J Neurosurg 2011; 115:730-6. [PMID: 21721878 DOI: 10.3171/2011.5.jns101768] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neoplastic meningitis (NM) is a debilitating and increasingly frequent neurological complication of cancer characterized by infiltration of tumor cells into the leptomeninges and the subarachnoid space. Although NM is rarely curable, combined intrathecal chemotherapy and focal radiation can improve disease-related symptoms and survival. Hydrocephalus occurs in a significant proportion of patients, is associated with poor prognosis and reduced quality of life, and usually precludes the use of intrathecal therapy. METHODS Since January of 2005, the authors have used a combined treatment approach for patients with both NM and hydrocephalus that employs a subcutaneously placed reservoir connected in series to an on/off valve and a ventriculoperitoneal shunt for both diversion of CSF and injection of intrathecal chemotherapy. They conducted a retrospective, case-controlled study from 2 independent institutions to review their experience. RESULTS Twenty-four patients with NM and hydrocephalus underwent placement of a CSF reservoir-on/off valve-ventriculoperitoneal shunt (RO-VPS) construct. There was no perioperative mortality, and there were only 2 minor complications. One shunt failure and no shunt-associated infections were observed over a median of 28 weeks of follow-up. Symptomatic improvement and improved performance status were seen in 20 patients (83.3%) and were sustained over 6 months. Eighteen patients received intraventricular chemotherapy without unexpected toxicity, and cytological responses were found in 11 patients (61.1%). Median progression-free and overall survival was 14 and 31 weeks, respectively. Compared with a contemporaneous comparison group of 24 demographically matched patients with NM who underwent CSF reservoir placement only, those who received RO-VPS constructs (p = 0.02) and had primary diagnosis of breast cancer (p = 0.04) had significant advantage in overall survival. CONCLUSIONS A combined RO-VPS system is safe and practical to install, results in symptomatic improvement in most patients, and allows uncomplicated and effective administration of intrathecal chemotherapy in patients with NM. Cerebrospinal fluid diversion surgery should be considered in NM patients in conjunction with intrathecal and systemic treatments.
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Affiliation(s)
- Ning Lin
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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A case of primary uterine cervical neuroendocrine tumor with meningeal carcinomatosis confirmed by diagnostic imaging and autopsy. Int J Clin Oncol 2010; 16:581-6. [DOI: 10.1007/s10147-010-0155-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
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Aphasic and visual aura with increased vasogenic leakage: An atypical migrainosus status. J Neurol Sci 2009; 285:227-9. [DOI: 10.1016/j.jns.2009.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 05/27/2009] [Accepted: 06/01/2009] [Indexed: 11/21/2022]
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Abstract
Leptomeningeal carcinomatosis (LMC) is an extremely rare manifestation of gastric cancer. The treatment options are very limited for LMC; despite standard treatment with intrathecal chemotherapy, the prognosis is grim and the median overall survival is 3-4 months. Here we report on a patient with LMC from metastatic gastric cancer who was treated with a novel approach of high-dose systemic irinotecan, comparable with the dose utilized in treating primary brain tumors such as gliomas. Our patient not only had an excellent tumor response to this novel approach, but also had a prolonged overall survival of 13 months, which is unusual for LMC from gastric cancer.
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Intradural squamous cell carcinoma in the sacrum. World J Surg Oncol 2009; 7:16. [PMID: 19208260 PMCID: PMC2644692 DOI: 10.1186/1477-7819-7-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 02/11/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leptomeningeal carcinomatosis occurs in patients with cancer at the rate of approximately 5%; it develops particularly in patients with breast cancer, lung cancer, melanoma, leukemia, or malignant lymphoma. We describe a rare case of leptomeningeal carcinomatosis in which spinal intradural squamous cell carcinoma with no lesions in the cerebral meninges and leptomeninx, was the primary lesion. METHODS A 64-year-old man complained of sacral pain. Although the patient was treated with analgesics, epidural block and nerve root block, sacral pain persisted. Since acute urinary retention occurred, he was operated on. The patient was diagnosed as having an intradural squamous cell carcinoma of unknown origin. RESULTS Since the patient presented with a slightly decreased level of consciousness 2 months after surgery, he was subjected to MRI scanning of the brain and spinal cord, which revealed disseminated lesions in the medulla oblongata. The patient died of pneumonia and sepsis caused by methicillin-resistant Staphylococcus aureus 5 months after surgery. CONCLUSION We report the first case of a patient with intradural squamous cell carcinoma with unknown origin that developed independently in the sacrum.
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