neoplastic meningitis
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Author(s):  
Anju Anna Abraham ◽  
Anoop T.M ◽  
Rona Joseph P. ◽  
Arun Vasudevan ◽  
Bhavya S. Kumar

Abstract Background Neoplastic meningitis (NM) is considered as a terminal event with poor prognosis. Its impact in clinical oncology is growing. Objective To analyze the clinical outcome of patients with carcinoma breast diagnosed with NM. Materials and Methods This study was an observational study in breast cancer patients diagnosed with NM. Patients with typical clinical symptoms and signs with either presence of cerebrospinal fluid (CSF) cytology positive for neoplastic cells or typical radiological features of leptomeningeal involvement in the presence of neurological symptoms or signs were taken as leptomeningeal metastasis (LM) or NM. The estimation of survival was done by Kaplan–Meier method. Results Out of 1,200 patients diagnosed with carcinoma breast during the study period, 15 developed NM. The median age of study population was 51 (range: 44–55) years. Most common presentations were headache (47%), vomiting (47%), diplopia (20%), seizure (20%), and cerebellar signs (7%). Seven (46%) patients were hormone receptor positive, four (30%) were HER2 (Human epidermal growth factor receptor 2) positive and seven (46%) were triple-negative breast cancer. Median time to develop LM from the time of diagnosis of breast cancer was 6 (range: 3–8) months. Nine patients (90%) had features of NM in CSF cytology. Thirteen patients received palliative whole brain radiotherapy (20 Gy in five fractions). Nine out of 12 patients received single-agent Capecitabine as first-line chemotherapy after palliative radiation therapy (RT). Intrathecal methotrexate was given for seven patients. The median overall survival was 3 (range: 0.5–4) months. Conclusion LM is a very aggressive metastatic disease with poor outcome. There is an unmet need for proper guidelines and an overwhelming necessity for a better focus on research for new modalities of disease in this scenario.


2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi152-vi152
Author(s):  
Taylor Perison ◽  
Kayla Wheat ◽  
Salim Gnabode ◽  
Lori Lyn Price ◽  
Suriya Jeyapalan

Abstract INTRODUCTION NM occurs in 5 - 15% of cancer patients and Overall Survival (OS) in treated patients ranges from 2-6 months. The purpose of this study was to analyze the effect of prognostic factors on OS and calculate a graded prognostic assessment (GPA) score based on tissue type, similar to the index score created for cancer patients with brain metastases (BM). METHODS We conducted a single center, retrospective analysis of 118 patients diagnosed between 2006 and 2018 at TMC. The prognostic factors analyzed were: Age (< = 50yo =1pt), Karnofsky Performance Status (KPS > =60 =1 pt), and no extracranial metastases (1pt). The GPA score was calculated from 0.0 - 3.0 by adding the points together. Kaplan Meier curves were used to estimate OS for primary tumors with 10 or more patients (breast, lung, leukemia, lymphoma). Cox regression analysis was used to evaluate the association of the GPA with OS. RESULTS The GPA analysis by tumor type included 76% of the patient population. The median OS was 5 months (breast), 2 months (lung), 7 months (leukemia), and 2 months (lymphoma). We found that leukemia (p =0.008, N = 20) and lung cancer (p =0.002, N = 20) patients showed distinct separation between GPA groups on their Kaplan Meier curves. Higher KPS was associated with increased OS (p < 0.0001) using Cox regression. DISCUSSION: The GPA algorithm was only partially successful in our NM population, which may reflect the smaller number of patients in our study compared to the studies used to create the BM GPA. TMC is a contributing institution to a large, multi-institutional, multi-national registry of patients with NM disease (Neoplastic Meningitis Registry - NeMeRe). We plan to use this larger dataset to validate our GPA score as a useful tool for predicting OS in NM patients.


2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii11-iii11
Author(s):  
Florencia Yorio ◽  
Juan Bautista Blaquier ◽  
Bernadette Calabrese ◽  
Sebastián Cerrato ◽  
Blanca Diez ◽  
...  

Abstract Background Neoplastic Meningitis (NM) is a lethal complication of cancer. Its incidence is rising and in 10% of the cases NM is the first manifestation of the disease. Diagnosis relies on the clinical manifestations, neuroimages, and finding of malignant cells in cerebrospinal fluid (CSF). Diagnosis is often challenging due to the low sensitivity of the different diagnostic modalities. The aim of this study is to identify the clinical features, diagnosis, treatment and outcome of lung cancer patients with NM. Methods Clinical records from patients with diagnosis of lung cancer and NM between 2011–2021 were retrospectively reviewed at a tertiary neurological center in Buenos Aires, Argentina. Results Twenty-seven patients were included. Median age was 58 years (IQR 52–64). 17 (65%) were female. Twenty-four patients had non-small cell lung cancer (91% adenocarcinoma), two had neuroendocrine lung cancer and one small cell lung cancer. In 19 (70%), meningeal involvement was a result of progressive disease from previously diagnosed cancer. In 12 (44%) patients meningeal disease developed posterior to parenchymal brain metastases surgical approach, 5 (41%) with posterior fossa craniotomy. Headache was the most frequent symptom (53%). CSF analysis was abnormal in 13 (48%) patients, with positive cytology in 10 (37%). Meningeal enhancement was detected with magnetic resonance imaging of brain or spine in 24 (92%) patients. Twenty-one (77%) patients received oncological treatment, 14 (51%) with chemotherapy (8 systemic, 3 intrathecal and 3 intrathecal plus systemic). Thirteen (48%) patients underwent treatment with either immunotherapy or target-therapy. 11 patients underwent whole brain radiotherapy. Median overall survival was 7 months (CI 95%: 3.5–10.4). Conclusion Headache was the most frequent symptom. Ninety-two percent of patients had meningeal pathological enhancement in high-quality MRI with gadolinium contrast of brain and spine. Despite median survival was poor (7 months), small subsets of these patients (22%) survived more than 2 years.


2021 ◽  
Vol 59 (3) ◽  
pp. 409-423
Author(s):  
Sangam Kanekar ◽  
Thomas Zacharia ◽  
Amit Agarwal

2021 ◽  
Vol 14 (3) ◽  
pp. e238808
Author(s):  
Santosh Sriram Andugulapati ◽  
Akash Chheda ◽  
Karan Desai ◽  
Sangeeta Hasmukh Ravat

A diagnosis of idiopathic intracranial hypertension should be considered only after careful exclusion of all possible aetiologies. We report a case of neoplastic meningitis presenting as intracranial hypertension with inconclusive repeated cerebrospinal fluid (CSF) cytology and MRI of brain, emphasising the importance of meticulous CSF analysis and role of early whole-body PET–CT scan for diagnosis of systemic malignancy.


Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 966
Author(s):  
Raffaele Di Francia ◽  
Stefania Crisci ◽  
Angela De Monaco ◽  
Concetta Cafiero ◽  
Agnese Re ◽  
...  

Cytarabine is a pyrimidine nucleoside analog, commonly used in multiagent chemotherapy regimens for the treatment of leukemia and lymphoma, as well as for neoplastic meningitis. Ara-C-based chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. Several studies suggest that the individual variability in clinical response to Leukemia & Lymphoma treatments among patients, underlying either Ara-C mechanism resistance or toxicity, appears to be associated with the intracellular accumulation and retention of Ara-CTP due to genetic variants related to metabolic enzymes. Herein, we reported (a) the latest Pharmacogenomics biomarkers associated with the response to cytarabine and (b) the new drug formulations with optimized pharmacokinetics. The purpose of this review is to provide readers with detailed and comprehensive information on the effects of Ara-C-based therapies, from biological to clinical practice, maintaining high the interest of both researcher and clinical hematologist. This review could help clinicians in predicting the response to cytarabine-based treatments.


2020 ◽  
Vol 8 (12) ◽  
pp. 2969-2972
Author(s):  
Catriona Davidson ◽  
Katerina Achilleos ◽  
Francesca Crawley ◽  
William Petchey

2020 ◽  
Author(s):  
Jingyi Fan ◽  
Ping Gao ◽  
Junying He ◽  
Yueli Zou ◽  
Litian Yan ◽  
...  

Abstract Background: Neoplastic meningitis refers to malignant tumors invading the meninges and subarachnoid spaces, causing intracranial metastases similar to meningitis. Discovery of tumor cells in the cerebrospinal fluid is the gold standard for its diagnosis. In China, meningeal metastasis of breast cancer is a relatively rare type. Methods: The clinical characteristics, imaging data, cerebrospinal fluid cytology and treatment options of 6 patients with meningeal metastasis of breast cancer treated in our hospital were analyzed. Results: The median age of Neoplastic meningitis was 50 years old. The cerebrospinal fluid pressure of the 6 patients increased to varying degrees and tumor cells were found in the cerebrospinal fluid. Of the 6 patients, 2 received only supportive care, and the rest received chemotherapy and intrathecal injection. The shortest survival time was 1 week, and the longest survival time was over 33.2 weeks. Conclusions: Patients whose initial Karnofsky Performance Scale scores were good and who received active and regular treatment after the diagnosis of NM had long overall survival time.


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