Leptomeningeal metastases in the MRI era Journal Article

Authors: Clarke, J. L.; Perez, H. R.; Jacks, L. M.; Panageas, K. S.; Deangelis, L. M.
Article Title: Leptomeningeal metastases in the MRI era
Abstract: Background: Diagnosis of leptomeningeal metastasis (LM) has become increasingly frequent. The diagnostic gold standard has been CSF cytology, but MRI is now used routinely for diagnosis. Diagnosis and prognosis of LM has not been studied in the MRI era. Methods: Patients with LM from 2002 through 2004 were identified through a neurology database, as well as by reviewing all abnormal CSF cytologies from a pathology database. Diagnosis was made by malignant cytology or imaging; suspicious cases treated as LM were also included. Results: A total of 187 patients with LM were analyzed in this retrospective review. Of these, 150 had solid and 37 had hematopoietic malignancies. Median age was 56.4 years, and median Karnofsky performance status (KPS) was 70. The most common types of solid tumor were breast (65 patients), lung (47), gastrointestinal (11), and melanoma (9). Of the hematopoietic tumors, 21 were lymphoma and 15 were leukemia. Fifty-three percent of patients were diagnosed by imaging, 23% by cytology, and 24% by both. Treatment included radiation therapy in 55%, intrathecal chemotherapy in 29%, and systemic chemotherapy in 18%; 21% received supportive care alone. Median overall survival was 2.4 (95% confidence interval 1.9-3.1) months. Median survival for patients with hematopoietic tumors was 4.7 months and for solid tumors was 2.3 months (p = 0.0006). In multivariate analysis, initial KPS and tumor type (solid vs hematopoietic) were significant predictors of survival. Conclusions: Despite enhanced diagnosis with MRI, prognosis remains poor in leptomeningeal metastasis. Those with hematopoietic tumors continue to fare better than those with solid tumors. Copyright © 2010 by AAN Enterprises, Inc.
Keywords: adult; human tissue; aged; aged, 80 and over; middle aged; leukemia; retrospective studies; young adult; major clinical study; overall survival; nuclear magnetic resonance imaging; outcome assessment; magnetic resonance imaging; neoplasms; melanoma; breast cancer; lung cancer; medical record review; digestive system cancer; kaplan-meiers estimate; karnofsky performance status; cerebrospinal fluid; meningeal neoplasms; lymphoma; neoplasm metastasis; multivariate analysis; databases, factual; carcinomatous meningitis; cerebrospinal fluid cytology
Journal Title: Neurology
Volume: 74
Issue: 18
ISSN: 0028-3878
Publisher: Lippincott Williams & Wilkins  
Date Published: 2010-05-04
Start Page: 1449
End Page: 1454
Language: English
DOI: 10.1212/WNL.0b013e3181dc1a69
PUBMED: 20439847
PROVIDER: scopus
PMCID: PMC2871005
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 20 April 2011" - "CODEN: NEURA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Jennifer L Clarke
    11 Clarke
  2. Katherine S Panageas
    428 Panageas
  3. Lindsay Jacks
    37 Jacks