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Impact of multimodality approach for patients with leptomeningeal metastases from solid tumors.

Kwon J, Chie EK, Kim K, Kim HJ, Wu HG, Kim IH, Oh DY, Lee SH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Ha SW - J. Korean Med. Sci. (2014)

Bottom Line: Median survival was 2.7 months and 1 yr survival rate was 11.3%.Subgroup analysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy had significant independent impact on survival (median survival; 10.5 vs. 3.0 months, P=0.008).Unlike previous reports, survival of patients with NSCLC primary was comparable to breast primary.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
The purpose of this study was to evaluate treatment patterns, outcome and prognosticators for patients with leptomeningeal metastases from solid tumor. Medical records of 80 patients from January 1, 2004 to May 31, 2011 were retrospectively reviewed. Most frequent site of origin was the lung (59%) followed by the breast (25%). Most patients were treated with intrathecal chemotherapy (90%) and/or whole brain radiotherapy (67.5%). Systemic therapy was offered to 27 patients (33.8%). Percentage of patients treated with single, dual, and triple modality were 32.5%, 43.8%, and 23.8%, respectively. Median survival was 2.7 months and 1 yr survival rate was 11.3%. Multivariate analysis showed that negative cerebrospinal fluid cytology, fewer chemotherapy regimen prior to leptomeningeal metastases, whole brain radiotherapy, systemic therapy, and combined modality treatment (median survival; single 1.4 vs. dual 2.8 vs. triple 8.3 months, P<0.001) had statistical significance on survival. Subgroup analysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy had significant independent impact on survival (median survival; 10.5 vs. 3.0 months, P=0.008). Unlike previous reports, survival of patients with NSCLC primary was comparable to breast primary. Furthermore, combined modality treatment for all patients and additionally targeted therapy for NSCLC patients should be considered in the treatment of leptomeningeal metastases from solid tumor.

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Overall survival according to combined modality treatment (A) and use of EGFR-TKI after diagnosis of leptomeningeal metastasis (B) in NSCLC patients.
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Figure 3: Overall survival according to combined modality treatment (A) and use of EGFR-TKI after diagnosis of leptomeningeal metastasis (B) in NSCLC patients.

Mentions: Unlike other solid tumors, target agents were commonly used in NSCLC patients. Further analysis was performed on EGFR-TKI and its associated factors. Evaluation of EGFR mutation was performed in 19 patients and 12 patients (32.4%) had gene mutation. Among patients without EGFR mutation analysis, 13 patients were suspected to have high probability of mutation based on two favorable clinical parameters, adenocarcinoma histology and never-smoking history. EGFR-TKI was prescribed to these patients based on this speculation. Detected or suspicious EGFR mutation had no significant impact on survival in univariate analysis (P=0.96). During the entire course of treatment for NSCLC and LM, 28 patients (75.7%) were exposed to EGFR-TKI and EGFR-TKI exposure was related with marginal prolongation of survival (P=0.056). Nineteen (51.4%) and 13 patients (35.1%) received the EGFR-TKI before and after LM diagnosis, respectively. Patients exposed to EGFR-TKI prior to LM diagnosis had a relatively short survival (P=0.034), whereas, EGFR-TKI after LM diagnosis led to statistically significant improvement in survival (P<0.001). Multivariate analysis revealed that positive CSF cytology, treatment of combined modality rather than single modality, and EGFR-TKI after LM diagnosis were statistically significant prognostic factors (Table 5, Fig. 3).


Impact of multimodality approach for patients with leptomeningeal metastases from solid tumors.

Kwon J, Chie EK, Kim K, Kim HJ, Wu HG, Kim IH, Oh DY, Lee SH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Ha SW - J. Korean Med. Sci. (2014)

Overall survival according to combined modality treatment (A) and use of EGFR-TKI after diagnosis of leptomeningeal metastasis (B) in NSCLC patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129201&req=5

Figure 3: Overall survival according to combined modality treatment (A) and use of EGFR-TKI after diagnosis of leptomeningeal metastasis (B) in NSCLC patients.
Mentions: Unlike other solid tumors, target agents were commonly used in NSCLC patients. Further analysis was performed on EGFR-TKI and its associated factors. Evaluation of EGFR mutation was performed in 19 patients and 12 patients (32.4%) had gene mutation. Among patients without EGFR mutation analysis, 13 patients were suspected to have high probability of mutation based on two favorable clinical parameters, adenocarcinoma histology and never-smoking history. EGFR-TKI was prescribed to these patients based on this speculation. Detected or suspicious EGFR mutation had no significant impact on survival in univariate analysis (P=0.96). During the entire course of treatment for NSCLC and LM, 28 patients (75.7%) were exposed to EGFR-TKI and EGFR-TKI exposure was related with marginal prolongation of survival (P=0.056). Nineteen (51.4%) and 13 patients (35.1%) received the EGFR-TKI before and after LM diagnosis, respectively. Patients exposed to EGFR-TKI prior to LM diagnosis had a relatively short survival (P=0.034), whereas, EGFR-TKI after LM diagnosis led to statistically significant improvement in survival (P<0.001). Multivariate analysis revealed that positive CSF cytology, treatment of combined modality rather than single modality, and EGFR-TKI after LM diagnosis were statistically significant prognostic factors (Table 5, Fig. 3).

Bottom Line: Median survival was 2.7 months and 1 yr survival rate was 11.3%.Subgroup analysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy had significant independent impact on survival (median survival; 10.5 vs. 3.0 months, P=0.008).Unlike previous reports, survival of patients with NSCLC primary was comparable to breast primary.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
The purpose of this study was to evaluate treatment patterns, outcome and prognosticators for patients with leptomeningeal metastases from solid tumor. Medical records of 80 patients from January 1, 2004 to May 31, 2011 were retrospectively reviewed. Most frequent site of origin was the lung (59%) followed by the breast (25%). Most patients were treated with intrathecal chemotherapy (90%) and/or whole brain radiotherapy (67.5%). Systemic therapy was offered to 27 patients (33.8%). Percentage of patients treated with single, dual, and triple modality were 32.5%, 43.8%, and 23.8%, respectively. Median survival was 2.7 months and 1 yr survival rate was 11.3%. Multivariate analysis showed that negative cerebrospinal fluid cytology, fewer chemotherapy regimen prior to leptomeningeal metastases, whole brain radiotherapy, systemic therapy, and combined modality treatment (median survival; single 1.4 vs. dual 2.8 vs. triple 8.3 months, P<0.001) had statistical significance on survival. Subgroup analysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy had significant independent impact on survival (median survival; 10.5 vs. 3.0 months, P=0.008). Unlike previous reports, survival of patients with NSCLC primary was comparable to breast primary. Furthermore, combined modality treatment for all patients and additionally targeted therapy for NSCLC patients should be considered in the treatment of leptomeningeal metastases from solid tumor.

Show MeSH
Related in: MedlinePlus