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Trifănescu OG, Mitrea D, Galeș LN, Ciornei A, Păun MA, Butnariu I, Trifănescu RA, Motaș N, Toma RV, Bîlteanu L, Gherghe M, Anghel RM. Therapies beyond Physiological Barriers and Drug Resistance: A Pilot Study and Review of the Literature Investigating If Intrathecal Trastuzumab and New Treatment Options Can Improve Oncologic Outcomes in Leptomeningeal Metastases from HER2-Positive Breast Cancer. Cancers (Basel) 2023; 15:2508. [PMID: 37173973 PMCID: PMC10177464 DOI: 10.3390/cancers15092508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/26/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
Leptomeningeal metastases (LM) are a rare but rapidly fatal complication defined by the spread of tumor cells within the leptomeninges and the subarachnoid space, found in approximately 10% of patients with HER2-positive breast cancers. This pilot study evaluated the efficacy of local treatment with intrathecal Trastuzumab (IT) added to systemic treatment. The oncologic outcome of 14 patients with HER2-positive LM is reported. Seven received IT, and seven received standard of care (SOC). The mean number of IT cycles administered was 12.14 ± 4.00. The response rate to CNS after IT treatment + SOC was 71.4%, and three patients (42.8%) obtained durable responses lasting more than 12 months. The median progression-free survival (mPFS) after LM diagnosis was six months, and the median overall survival (mOS) was ten months. The mean values of the PFS in favor of IT therapy (10.6 mo vs. 6.6 mo) and OS (13.7 vs. 9.3 mo) suggest a non-negligible investigation direction in the sense of exploiting intrathecal administration as a possible treatment modality in these patients. Adverse events reported were local pain related to intrathecal administration and one case of arachnoiditis, hematoma, and CSF fistulae. Intrathecal administration of Trastuzumab, alongside systemic treatment and radiotherapy, might improve oncologic outcomes in LM HER2-positive breast cancer with manageable toxicity.
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Affiliation(s)
- Oana Gabriela Trifănescu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Dan Mitrea
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
- Neuroaxis Neurology Clinic, 011302 Bucharest, Romania
| | - Laurenția Nicoleta Galeș
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Medical Oncology II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Ana Ciornei
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Mihai-Andrei Păun
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Ioana Butnariu
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania
| | - Raluca Alexandra Trifănescu
- Discipline of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 011863 Bucharest, Romania
- “C. I. Parhon” Institute of Endocrinology, 020021 Bucharest, Romania
| | - Natalia Motaș
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 020021 Bucharest, Romania
| | - Radu Valeriu Toma
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy I, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania;
| | - Liviu Bîlteanu
- Department of Radiotherapy I, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania;
| | - Mirela Gherghe
- Department of Nuclear Medicine, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
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2
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Singhal R, Daily K, Wheeler S. Systemic absorption of intrathecal methotrexate. BMJ Case Rep 2023; 16:e254027. [PMID: 37072302 PMCID: PMC10124216 DOI: 10.1136/bcr-2022-254027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Leptomeningeal spread of cancer is rare, difficult to both diagnostically confirm and treat, and associated with a poor prognosis. The blood-brain barrier largely prevents sufficient penetration of systemic therapy to be effective. Direct administration of intrathecal therapy has thus been used as an alternative treatment option. We present a case of breast cancer complicated by leptomeningeal spread. Intrathecal methotrexate was initiated, and the manifestation of systemic side effects suggested systemic absorption. This was subsequently confirmed by blood work showing detectable methotrexate levels following intrathecal administration as well as resolution of symptoms with reduction in the dose of methotrexate administered.
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Affiliation(s)
- Ruchi Singhal
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Karen Daily
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
| | - Sarah Wheeler
- Department of Pharmacy Services, University of Florida Health Shands Cancer Hospital, Gainesville, Florida, USA
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3
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Cunningham AR, Behm HE, Ju A, Peach MS. Long-Term Survival of Patients With Glioblastoma of the Pineal Gland: A ChatGPT-Assisted, Updated Case of a Multimodal Treatment Strategy Resulting in Extremely Long Overall Survival at a Site With Historically Poor Outcomes. Cureus 2023; 15:e36590. [PMID: 37095802 PMCID: PMC10122505 DOI: 10.7759/cureus.36590] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
We present an updated case report of a patient with glioblastoma isolated to the pineal gland with an overall survival greater than five years and no progression of focal central nervous system (CNS) deficits since initial presentation. The patient underwent radiotherapy up to 60 Gy with concurrent and adjuvant temozolomide with the use of non-standard treatment volumes that included the ventricular system. The utilization of ventricular irradiation as well as the addition of bevacizumab at disease recurrence may have encouraged this unusually long survival by preventing/delaying leptomeningeal spread. We also present an updated review of the literature, which shows a median survival of six months, reinforcing the patients atypical disease trajectory. Finally, we utilize OpenAI's language model ChatGPT to aid in synthesizing this manuscript. In doing so, we demonstrate that ChatGPT is apt at creating concise summaries of relevant literature and topic subjects, however its output is often repetitive with similar sentence/paragraph structure, less than ideal grammar and poor syntax requiring editing. Thus, in its current iteration, ChatGPT is a helpful aid that cuts down on the time spent in data acquisition and processing but is not a replacement for human input in the creation of quality medical literature.
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Affiliation(s)
- Andrew R Cunningham
- Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Hayley E Behm
- Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Andrew Ju
- Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Matthew S Peach
- Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, USA
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4
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Shim J, Reisner A, Esiashvili N, Rapkin L, Olson T. Intraventricular topotecan in the successful treatment of recurrent CNS pleuropulmonary blastoma. Pediatr Blood Cancer 2022; 69:e29529. [PMID: 34913589 DOI: 10.1002/pbc.29529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/12/2022]
Abstract
Pleuropulmonary blastoma (PPB) is a rare pediatric tumor of the pleura and pulmonary mesenchyme, associated with pathogenic germline DICER1 mutations. Although the most common site of metastasis is the central nervous system (CNS), patients with CNS metastasis have dismal outcome. We report a case of a patient presenting with type II PPB and intracranial and bone metastases. We describe a multimodal therapy approach and highlight the use of intraventricular topotecan for isolated CNS recurrence. In addition, a new pathogenic germline mutation heterozygous for the c.1234delT of DICER1 was identified. Patient remains in remission 3 years after recurrence.
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Affiliation(s)
- Jenny Shim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center at the Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andrew Reisner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurosurgery, Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, Georgia, USA
| | - Louis Rapkin
- Department of Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas Olson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center at the Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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5
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Rinehardt H, Kassem M, Morgan E, Palettas M, Stephens JA, Suresh A, Ganju A, Lustberg M, Wesolowski R, Sardesai S, Stover D, Vandeusen J, Cherian M, Prieto Eibl MDPG, Miah A, Alnahhas I, Giglio P, Puduvalli VK, Ramaswamy B, Williams N, Noonan AM. Assessment of Leptomeningeal Carcinomatosis Diagnosis, Management and Outcomes in Patients with Solid Tumors Over a Decade of Experience. Eur J Breast Health 2021; 17:371-377. [PMID: 34651117 DOI: 10.4274/ejbh.galenos.2021.2021-4-10] [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: 04/27/2021] [Accepted: 07/18/2021] [Indexed: 12/01/2022]
Abstract
Objective Leptomeningeal carcinomatosis (LMC), a common complication of advanced malignancies, is associated with high morbidity and mortality, yet diagnosis and treatment decisions remain challenging. This study describes the diagnostic and treatment modalities for LMC and identifies factors associated with overall survival (OS). Materials and Methods We performed a single-institution retrospective study (registration #: OSU2016C0053) of 153 patients diagnosed with LMC treated at The Ohio State University, Comprehensive Cancer Center, (OSUCCC)-James between January 1, 2010 and December 31, 2015. Results Median age at diagnosis was 55.7 years, and 61% had Eastern Cooperative Oncology Group baseline performance status ≤1. Most common primary tumors were breast (43%), lung (26%), and cutaneous melanoma (10%). At presentation, most patients were stage III-IV (71%) with higher grade tumors (grade III: 46%). Metastases to bone (36%), brain (33%), and lung (12%) were the most common sites with a median of 0.5 years (range, 0-14.9 years) between the diagnosis of first metastasis and of LMC. 153 (100%) patients had MRI evidence of LMC. Of the 67 (44%) who underwent lumbar puncture (LP), 33 (22%) had positive cerebrospinal fluid (CSF) cytology. Most patients received radiotherapy for LMC (60%) and chemotherapy (93%) for either the primary disease or LMC. 28 patients received intrathecal chemotherapy, 22 of whom had a primary diagnosis of breast cancer. 98% died with median OS of all patients was 1.9 months (95% CI: 1.3-2.5 months). Conclusion Despite improved treatments and targeted therapies, outcomes of LMC remain extremely poor. Positive CSF cytology was associated with lower OS in patients who had cytology assessed and specifically in patients with breast cancer. CSF cytology serves as an important indicator for prognosis and helps aid in developing individualized therapeutic strategies for patients with LMC.
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Affiliation(s)
- Hannah Rinehardt
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mahmoud Kassem
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Evan Morgan
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine Columbus, OH, USA
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine Columbus, OH, USA
| | - Anupama Suresh
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Akansha Ganju
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Maryam Lustberg
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Robert Wesolowski
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Sagar Sardesai
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Daniel Stover
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Jeffrey Vandeusen
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Mathew Cherian
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | | | - Abdul Miah
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Iyad Alnahhas
- Division of Neuro-oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pierre Giglio
- Division of Neuro-oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vinay K Puduvalli
- Division of Neuro-oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Nicole Williams
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, USA
| | - Anne M Noonan
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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6
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Lin Y, Li H, Huang M, Yin Z, Wu J. [Auxiliary Diagnostic Value of Tumor Markers in the Cerebrospinal Fluid and Blood for Leptomeningeal Metastasis from Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:516-525. [PMID: 32517459 PMCID: PMC7309546 DOI: 10.3779/j.issn.1009-3419.2020.103.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
背景与目的 软脑膜转移(leptomeningeal metastasis, LM)是指恶性肿瘤细胞浸润软脑膜,并在脑脊液(cerebrospinal fluid, CSF)中播散,预后极差,是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者致死的重要原因之一,因此早期的诊断和及时的治疗具有重要意义,CSF细胞学是LM诊断的金标准,但常常伴随着检测敏感性低、无法评估疗效等问题。本文旨在探讨血清及CSF中肿瘤标志物(tumor markers, TM)在NSCLC伴LM患者诊治的临床价值。 方法 选取NSCLC伴LM患者19例,另选同期27例神经系统良性肿瘤(nonmalignant neurological diseases, NMNDs)患者作为对照组。观察比较两组患者血清和CSF中癌胚抗原(carbohydrate antigen, CEA)、糖类抗原125(carbohydrate antigen-125, CA125)、细胞角蛋白19片断抗原(cytokeratin 19 fragments, CYFRA21-1)和神经元烯醇化酶(neurone specific enolase, NSE)检测水平和检出阳性率,比较不同组TM的敏感性和特异性,并分析血清与CSF中TM检出情况相关性,最后动态监测2例LM患者血清和CSF中TM水平,分别评估颅外和颅内治疗疗效。 结果 LM组CSF和血清中TM水平和检出阳性率均高于对照组(P < 0.05),同时LM组CSF中CEA、CYFRA21-1、NSE水平高于血清,差异有统计学意义(P < 0.05)。CSF中TM检出阳性率与血清差异不具有统计学意义(P > 0.05)。CSF中CYFRA21-1敏感性最高(88.2%),CEA特异性最好(92.3%),联合指标中CEA或NSE任一项超过临界值则敏感性和阴性预测值为100%,特异性为74.1%。CYFRA21-1和NSE同时超过临界值时特异性和阳性预测值为100%,敏感性为78.9%。亚组分析显示,CSF细胞学阳性人群TM检出阳性率超过有磁共振成像(magnetic resonance imaging, MRI)异常的人群,但不具有统计学差异(P > 0.05)。LM组血清与CSF中TM检出阳性率不一致。另外,脑室中CSF与腰穿中CSF具有相同的生化性质,动态监测血清和CSF中TM浓度,可分别评估颅外和颅内病灶的疗效。 结论 血清和CSF中TM为NSCLC伴LM患者增加了一个早期辅助诊断指标,动态监测可评估治疗疗效,值得临床推广应用。
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Affiliation(s)
- Yongjuan Lin
- Department of Geriatric, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Huiying Li
- Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Mingmin Huang
- Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Zhenyu Yin
- Department of Geriatric, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Jianqing Wu
- Department of Geriatric, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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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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8
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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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9
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Walker DA, Meijer L, Coyle B, Halsey C. Leptomeningeal malignancy of childhood: sharing learning between childhood leukaemia and brain tumour trials. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:242-250. [PMID: 31958415 DOI: 10.1016/s2352-4642(19)30333-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 01/02/2023]
Abstract
Leptomeningeal malignancy complicates childhood cancers, including leukaemias, brain tumours, and solid tumours. In leukaemia, such malignancy is thought to invade leptomeninges via the vascular route. In brain tumours, dissemination from the primary tumour, before or after surgery, via CSF pathways is assumed; however, evidence exists to support the vascular route of dissemination. Success in treating leptomeningeal malignancy represents a rate-limiting step to cure, which has been successfully overcome in leukaemia with intensified systemic therapy combined with intra-CSF therapy, which replaced cranial radiotherapy for many patients. This de-escalated CNS-directed therapy is still associated with some neurotoxicity. The balanced benefit justifies exploration of ways to further de-escalate CNS-directed therapy. For primary brain tumours, standard therapy is craniospinal radiotherapy, but attendant risk of acute and delayed brain injury and endocrine deficiencies compounds post-radiation impairment of spinal growth. Alternative ways of treating leptomeninges by intensifying drug therapy delivered to CSF are being investigated-preliminary evidence suggests improved outcomes. This Review seeks to describe methods of intra-CSF drug delivery and drugs in use, and consider how the technique could be modified and additional drugs might be selected for this route of administration.
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Affiliation(s)
- David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, School of Medicine, Queen's Medical Centre, Nottingham, UK.
| | - Lisethe Meijer
- Department of Paediatric Neuro-Oncology, Prinses Maxima Center for Paediatric Oncology, Bilthoven, Netherlands
| | - Beth Coyle
- Children's Brain Tumour Research Centre, University of Nottingham, School of Medicine, Queen's Medical Centre, Nottingham, UK
| | - Christina Halsey
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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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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11
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Ponce S, Bruna J, Juan O, López R, Navarro A, Ortega AL, Puente J, Verger E, Bartolomé A, Nadal E. Multidisciplinary expert opinion on the treatment consensus for patients with EGFR mutated NSCLC with brain metastases. Crit Rev Oncol Hematol 2019; 138:190-206. [PMID: 31092376 DOI: 10.1016/j.critrevonc.2019.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/09/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022] Open
Abstract
The presence of an epidermal growth factor receptor (EGFR) mutation is associated with higher incidence of brain metastases in patients with non-small cell lung cancer (NSCLC); however, patients with synchronous brain metastases at diagnosis have generally been excluded from clinical trials. As there is limited clinical evidence for managing this patient population, a multidisciplinary group of Spanish medical and radiation oncologists, and neuro-oncologist with expertise treating brain metastases in lung cancer patients met with the aim of reaching and developing an expert opinion consensus on the management of patients with EGFR mutated NSCLC with brain metastases. This consensus contains 26 recommendations and 20 conclusion statements across 21 questions in 7 areas, as well as a first-line treatment algorithm.
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Affiliation(s)
- Santiago Ponce
- Lung Cancer Clinical Research Unit, Hospital Universitario 12 de Octubre, Av. Cordoba, s/n, 28041 Madrid, Spain.
| | - Jordi Bruna
- Neuro-Oncology Unit, Bellvitge University Hospital-ICO, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Research in Solid Tumors (CReST) and Neuro-Oncology Group. Oncobell, IDIBELL, Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Oscar Juan
- Medical Oncology Service, Hospital Universitario y Politécnico La Fe, Valencia, Avda. de Fernando Abril Martorell, nº 106, 46026, Valencia, Spain.
| | - Rafael López
- Medical Oncology Unit. Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.
| | - Alejandro Navarro
- Medical Oncology. Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Ana Laura Ortega
- Oncology Research Unit, Complejo Hospitalario de Jaén, Av. del Ejército Español, 10, 23007, Jaén, Spain.
| | - Javier Puente
- GU, Thoracic and Melanoma Cancer Unit, Medical Oncology Department, Assistant Professor of Medicine, Complutense University. Hospital Clinico Universitario San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Eugènia Verger
- Radiation Oncology Department, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Adela Bartolomé
- Radiotherapy Oncology Department. Hospital Universitario 12 de Octubre, Av. Cordoba, s/n, 28041, Madrid, Spain.
| | - Ernest Nadal
- Clinical Research in Solid Tumors (CReST) and Neuro-Oncology Group. Oncobell, IDIBELL, Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology. Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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12
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Nayar G, Ejikeme T, Chongsathidkiet P, Elsamadicy AA, Blackwell KL, Clarke JM, Lad SP, Fecci PE. Leptomeningeal disease: current diagnostic and therapeutic strategies. Oncotarget 2017; 8:73312-73328. [PMID: 29069871 PMCID: PMC5641214 DOI: 10.18632/oncotarget.20272] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/20/2017] [Indexed: 12/28/2022] Open
Abstract
Leptomeningeal disease has become increasingly prevalent as novel therapeutic interventions extend the survival of cancer patients. Although a majority of leptomeningeal spread occurs secondary to breast cancer, lung cancer, and melanoma, a wide variety of malignancies have been reported as primary sources. Symptoms on presentation are equally diverse, often involving a combination of neurological deficits with the possibility of obstructive hydrocephalus. Diagnosis is definitively made via cerebrospinal fluid cytology for malignant cells, but neuro-imaging with high quality T1-weighted magnetic resonance imaging can aid diagnosis and localization. While leptomeningeal disease is still a terminal, late-stage complication, a variety of treatment modalities, such as intrathecal chemotherapeutics and radiation therapy, have improved median survival from 4–6 weeks to 3–6 months. Positive prognosticative factors for survival include younger age, high performance scores, and controlled systemic disease. In looking to the future, diagnostics that improve early detection and chemotherapeutics tailored to the primary malignancy will likely be the most significant advances in improving survival.
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Affiliation(s)
- Gautam Nayar
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Tiffany Ejikeme
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Pakawat Chongsathidkiet
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Aladine A Elsamadicy
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Kimberly L Blackwell
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey M Clarke
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Peter E Fecci
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
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13
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Rigakos G, Liakou CI, Felipe N, Orkoulas-Razis D, Razis E. Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis. Cancer Control 2017; 24:9-21. [DOI: 10.1177/107327481702400103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | - Naillid Felipe
- Hygeia Hospital, Athens, Greece, Boston University School of Medicine, Baltimore, Maryland
| | - Dennis Orkoulas-Razis
- Boston, Massachusetts, and University of Maryland School of Medicine, Baltimore, Maryland
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14
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Lv X, He J, Shen Y, Zheng H. Malignant pleural and pericardial effusions and meningeal infiltrates without other metastases in breast cancer: A case report. Mol Clin Oncol 2016; 4:855-858. [PMID: 27123295 DOI: 10.3892/mco.2016.798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/25/2016] [Indexed: 02/05/2023] Open
Abstract
Breast cancer metastasizing to the pleura, pericardium and leptomeninges, but not to other sites, is rare. Although malignant pericardial and pleural effusions are common complications during the course of malignancies, they are rarely the initial manifestations of malignant disease, particularly pericardial effusion with cardiac tamponade. This report describes a case of breast carcinoma in a 44-year-old woman who initially presented with malignant pleural effusion and pericardial tamponade and suffered from meningeal metastases after 4.5 months. Unfortunately, the patient succumbed to pericardial tamponade 7 months later. There was no metastasis identified in other organs during the course of the disease. To the best of our knowledge, no similar case has been reported in the literature to date.
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Affiliation(s)
- Xingxing Lv
- Department of Head & Neck and Mammary Oncology and Medical Oncology, Cancer Center and State Key Laboratory of Biotherapy, Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Jinlan He
- Department of Head & Neck and Mammary Oncology and Medical Oncology, Cancer Center and State Key Laboratory of Biotherapy, Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Yuan Shen
- Department of General Practice, West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong Zheng
- Department of Head & Neck and Mammary Oncology and Medical Oncology, Cancer Center and State Key Laboratory of Biotherapy, Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Chengdu, Sichuan 610041, P.R. China
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15
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Abstract
Intramedullary, intradural/extramedullary, and extradural spine tumors comprise a wide range of neoplasms with an even wider range of clinical symptoms and prognostic features. Magnetic resonance imaging (MRI), commonly used to evaluate the spine in patients presenting with pain, can further characterize lesions that may be encountered on other imaging studies, such as bone scintigraphy or computed tomography (CT). The advantage of the MRI is its multiplane capabilities, superior contrast agent resolution, and flexible protocols that play an important role in assessing tumor location, extent in directing biopsy, in planning proper therapy, and in evaluating therapeutic results. A multimodality approach can be used to fully characterize the lesion and the combination of information obtained from the different modalities usually narrows the diagnostic possibilities significantly. The diagnosis of spinal tumors is based on patient age, topographic features of the tumor, and lesion pattern, as seen at CT and MRI. The shift to high-end imaging incorporating diffusion-weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy, whole-body short tau inversion recovery, positron emission tomography, intraoperative and high-field MRI as part of the mainstream clinical imaging protocol has provided neurologists, neuro-oncologists, and neurosurgeons a window of opportunity to assess the biologic behavior of spine neoplasms. This chapter reviews neuroimaging of spine tumors, primary and secondary, discussing routine and newer modalities that can reduce the significant morbidity associated with these neoplasms.
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16
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Diagnostic and prognostic significance of flow cytometry immunophenotyping in patients with leptomeningeal carcinomatosis. Clin Exp Metastasis 2015; 32:383-91. [PMID: 25795393 DOI: 10.1007/s10585-015-9716-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
Some patients with epithelial-cell cancers develop leptomeningeal carcinomatosis (LC), a severe complication difficult to diagnose and with an adverse prognosis. This study explores the contribution of flow cytometry immunophenotyping (FCI) to the diagnosis and prognosis of LC. Cerebrospinal fluid (CSF) samples from patients diagnosed with LC were studied using FCI. Expression of the epithelial-cell adhesion molecule (EpCAM) was the criterion used to identify the epithelial cells. To test the diagnostic precision, 144 patients (94 diagnosed with LC) were included. The prognostic value of FCI was evaluated in 72 patients diagnosed with LC and eligible for therapy. Compared with cytology, FCI showed greater sensitivity and negative predictive value (79.79 vs. 50%; 68.85 vs. 51.55%, respectively), but lower specificity and positive predictive value (84 vs. 100%; 90.36 vs. 100%, respectively). The multivariate analysis revealed that the percentage of CSF EpCAM+ cells predicted an increased risk of death (HR: 1.012, 95% CI 1.000-1.023; p=0.041). A cut-off value of 8% EpCAM+ cells in the CSF distinguished two groups of patients with statistically significant differences in overall survival (OS) (p=0.018). This cut-off value kept its statistical significance regardless of the absolute CSF cell-count. The FCI study of the CSF improved the sensitivity for diagnosing LC, but refinement of the technique is needed to improve specificity. Furthermore, quantification of CSF EpCAM+ cells was revealed to be an independent prognostic factor for OS in patients with LC eligible for therapy. An 8% cut-off value contributed to predicting clinical evolution before initiation of therapy.
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17
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Illán J, Simo M, Serrano C, Castañón S, Gonzalo R, Martínez-García M, Pardo J, Gómez L, Navarro M, Altozano JP, Alvarez R, Bruna J, Subirá D. Differences in cerebrospinal fluid inflammatory cell reaction of patients with leptomeningeal involvement by lymphoma and carcinoma. Transl Res 2014; 164:460-7. [PMID: 24746871 DOI: 10.1016/j.trsl.2014.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 12/24/2022]
Abstract
Dissemination of neoplastic cells into the cerebrospinal fluid (CSF) and leptomeninges is a devastating complication in patients with epithelial cell neoplasia (leptomeningeal carcinomatosis [LC]) and lymphomas (lymphomatous meningitis [LyM]). Information about the surrounding inflammatory cell populations is scarce. In this study, flow cytometry immunophenotyping was used to describe the distribution of the main leukocyte populations in the CSF of 83 patients diagnosed with neoplastic meningitis (LC, n = 65; LyM, n = 18). These data were compared with those obtained in the CSF from 55 patients diagnosed with the same groups of neoplasia without meningeal involvement (solid tumors, n = 36; high-grade lymphoma, n = 19). Median (interquartile) rates of lymphocytes, monocytes, and polymorphonuclear (PMN) cells were 59.7% (range, 35-76.6%), 24% (range, 16-53%), and 1.5% (range, 0-7.6%) in LC, respectively, and 98.5% (range, 70.8-100%), 1.5% (range, 0-29.3%), and 0% in LyM, respectively (P < 0.001). No difference was observed between patients with breast adenocarcinoma (n = 30) and lung adenocarcinoma (n = 21), nor with different rates of malignant CSF involvement. Patients with lymphoma (with or without LyM) had a similar CSF leukocyte distribution, but cancer patients with LC and without LC had a distinctive PMN cell rate (P = 0.002). These data show that CSF samples from patients with LC have a greater number of inflammatory cells and a different leukocyte distribution than seen in the CSF from patients with LyM. Description of PMN cells is a distinctive parameter of patients with LC, compared with the CSF from patients with LyM and patients with cancer but without LC.
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Affiliation(s)
- Julia Illán
- Unilabs Diagnósticos, SLU, c/Juan Esplandiú 15, Madrid 28007, Spain
| | - Marta Simo
- Unit of Neuro-Oncology, Departments of Oncology and Neurology, Hospital Universitario de Bellvitge-ICO Duran i Reynals, Avda. Gran Vía s/n km 2.7, Hospitalet de Llobregat 08907, Spain
| | - Cristina Serrano
- Department of Hematology, Fundación Jiménez Díaz, Plaza Cristo Rey 1, Madrid 28040, Spain
| | - Susana Castañón
- Department of Hematology, Fundación Jiménez Díaz, Plaza Cristo Rey 1, Madrid 28040, Spain
| | - Raquel Gonzalo
- Department of Hematology, Fundación Jiménez Díaz, Plaza Cristo Rey 1, Madrid 28040, Spain
| | - María Martínez-García
- Department of Oncology, Hospital del Mar, Paseo Marítimo 25-29, Barcelona 08003, Spain
| | - Javier Pardo
- Department of Neurology, Hospital Rey Juan Carlos, c/Gladiolo s/n, Móstoles 28933, Spain
| | - Lidia Gómez
- Department of Neurology, Hospital Quirón Madrid, c/Diego de Velázquez 1, Pozuelo de Alarcón 28223, Madrid, Spain
| | - Miguel Navarro
- Department of Oncology, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, Salamanca 37007, Spain
| | - Javier Pérez Altozano
- Department of Oncology, Hospital General de Elche, Cami de L'Almassera, Elche 03203, Spain
| | - Ruth Alvarez
- Department of Oncology, Hospital Virgen de la Salud, Avda. de Barber, 30, Toledo 45004, Spain
| | - Jordi Bruna
- Unit of Neuro-Oncology, Departments of Oncology and Neurology, Hospital Universitario de Bellvitge-ICO Duran i Reynals, Avda. Gran Vía s/n km 2.7, Hospitalet de Llobregat 08907, Spain
| | - Dolores Subirá
- Department of Hematology, Hospital de Guadalajara, c/Donantes de sangre s/n, Guadalajara 19002, Spain.
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Long-term stabilization of leptomeningeal disease with whole-brain radiation therapy in a patient with metastatic melanoma treated with vemurafenib: a case report. Melanoma Res 2014; 23:175-8. [PMID: 23358426 DOI: 10.1097/cmr.0b013e32835e589c] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present a patient with metastatic BRAF-mutated melanoma who achieved long-term stabilization of leptomeningeal disease (LMD) with sequential whole-brain radiation therapy and vemurafenib. A 53-year-old woman with melanoma that harbored the BRAF V600E mutation and had that metastasized to multiple lymph nodes, lungs, breast, and subcutaneous tissue had developed symptomatic LMD 16 months after starting vemurafenib treatment despite achieving a substantial response at the existing metastatic sites. Vemurafenib was discontinued for 7 days, she received whole-brain radiation therapy (30 Gy in 10 fractions), and 7 days after completing the radiation therapy, she resumed vemurafenib therapy. The neurologic symptoms improved significantly, and a cerebrospinal fluid examination revealed disappearance of melanoma cells. She remained alive with radiologically stable LMD for at least 18 months after the whole-brain radiation therapy.
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