1
|
Wegener E, Horsley P, Wheeler H, Jayamanne D, Kastelan M, Guo L, Brown C, Back M. Leptomeningeal neuraxis relapse in glioblastoma is an uncommon but not rare event associated with poor outcome. BMC Neurol 2023; 23:328. [PMID: 37715122 PMCID: PMC10503008 DOI: 10.1186/s12883-023-03378-1] [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] [Received: 05/31/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Spinal neuraxis leptomeningeal metastasis (LM) relapse in glioblastoma is an uncommon event that is challenging to manage. This study aims to determine the incidence, associated factors, and outcome of LM relapse in patients with glioblastoma managed with radical intent. METHODS Patients managed for glioblastoma using the EORTC-NCIC (Stupp) Protocol from 2007 to 2019 were entered into a prospective ethics-approved database. Follow-up included routine cranial MRI surveillance with further imaging as clinically indicated. LM relapse was determined by MRI findings and/or cerebrospinal fluid analysis. The chi-square test of independence was used to evaluate clinico-pathologic factors associated with increased risk of subsequent LM relapse. Median survival post-LM relapse was calculated using Kaplan-Meier technique. RESULTS Four-hundred-and-seven patients were eligible, with median follow-up of 60 months for surviving patients. Eleven (2.7%) had LM at first relapse and in total 21 (5.1%) experienced LM in the entire follow-up period. Sites of LM relapse were 8 (38%) focal spinal, 2 (10%) focal brainstem medulla and 11 (52%) diffuse spinal. Median overall survival from initial diagnosis for the entire cohort was 17.6 months (95% CI 16.7-19.0). Median survival from LM relapse to death was 39 days (95% CI: 19-107). Factors associated with LM relapse were age less than 50 years (p < 0.01), initial disease located in the temporal lobe (p < 0.01) and tumours lacking MGMT promoter methylation (p < 0.01). CONCLUSIONS LM relapse is an uncommon but not rare event in patients managed radically for glioblastoma. It is associated with poor outcome with the majority of patients deceased within two months of recognition.
Collapse
Affiliation(s)
- Eric Wegener
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
| | - Patrick Horsley
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia.
| | - Helen Wheeler
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
- The Brain Cancer group, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Dasantha Jayamanne
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Linxin Guo
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, Sydney, Australia
| | - Michael Back
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
- The Brain Cancer group, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Genesis Cancer Care, Sydney, Australia
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| |
Collapse
|
2
|
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
| | | |
Collapse
|
3
|
Leptomeningeal metastases: What nurses need to know. Nursing 2015; 45:30-6; quiz 37. [PMID: 26544509 DOI: 10.1097/01.nurse.0000473391.13435.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
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.
Collapse
|
5
|
Holter JL, Thorp K, Smith ML, Kedzierska K, Fung KMA, Chacko G, Swisher K, Epstein R, Gumerlock MK. [18F]fluorothymidine PET imaging in the diagnosis of leptomeningeal involvement with diffuse large B-cell lymphoma. Cancer Imaging 2011; 11:140-3. [PMID: 22004872 PMCID: PMC3205762 DOI: 10.1102/1470-7330.2011.0020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of leptomeningeal carcinomatosis remains difficult despite improvement in central nervous system (CNS) imaging and cytologic examination of the cerebral spinal fluid. False-negative results are common, providing obstacles in assessing both prophylactic and therapeutic efforts. As a result of increased survival of patients with a variety of systemic neoplasms it is likely that central nervous involvement will need to be addressed more often. This article presents a patient with a diffuse large B-cell lymphoma with polymorphic features. Imaging using 18F-labeled fluorodeoxythymidine (FLT) proved useful in demonstrating both parenchymal and leptomeningeal CNS involvement. The potential for FLT to identify proliferative tissue may make it uniquely suitable for detection of CNS malignant disease.
Collapse
Affiliation(s)
- Jennifer L Holter
- Section of Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|