Central Nervous System

PD 03 - CNS 1 - Poster Discussion - Toxicity and Quality of Life

1018 - The Diagnosis and Comprehensive Treatment of Leptomeningeal Metastasis: A Phase II Trial

Sunday, October 21
4:45 PM - 4:51 PM
Location: Room 217 A/B

The Diagnosis and Comprehensive Treatment of Leptomeningeal Metastasis: A Phase II Trial
S. Yang1, J. Xiao2, Y. Ma3, R. Zhao1, H. Zhang1, Y. Xu1, Y. Tian1, N. Bi2, Y. Zhang4, Q. Liu1, X. Chen1, and Y. Li3; 1National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 3National Cancer Canter/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 4Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Purpose/Objective(s): A prospective phase II trial was conducted to investigate the diagnosis of leptomeningeal metastases (LMs) and clinical outcomes of comprehensive treatment.

Materials/Methods: Patients who were clinically suspected to have LMs and received comprehensive treatment based on tomotherapy were enrolled. Whole brain radiotherapy (WBRT) with or without simultaneously boost to LM or craniospinal irradiation (CSI) was given to them. The diagnosis and response were assessed by the results of enhanced MRI, clinical signs and symptoms, cerebrospinal fluid (CSF) cytology and liquid biopsy and liquid genomics detection. The primary endpoint was local control (LC), and the secondary endpoints were intracranial progression-free survival (IPFS) and overall survival (OS). Kaplan-Meier method was used.

Results: From 2014 to 2017, 88 patients were enrolled (Male: Female=36:52), and the median age was 55 years old (range, 29-81). The major primary diagnosis was non-small cell lung cancer (64.8%). Typical clinical signs included cerebral (70.5%), cranial nerve palsies (30.7%), and spinal complaints (33.0%). 20.5% of patients showed no obvious symptoms. MRI findings before treatment included 4 types: multiple brain metastases (BMs) with focal LMs, large BMs invaded meningeal, extensive LMs and LMs proved by clinical symptoms or CSF without changes in MRI. The lesions appeared as nodular (67.1%), linear enhancement (18.2%), both (10.2%), or narrowing brain fold without other appearance (4.5%). MRI changes after radiation mainly included decreased lesions and weakened enhancement (65.9%), increased and strengthened followed by decreased lesions and weakened enhancement (18.2%), and increased lesions and strengthened enhancement but with cystic change (5.7%). 9 patients were diagnosed with distinct spinal cord metastases. 31 patients received lumbar puncture, and CSF cytology mainly showed increased leukocyte counts (64.5%), evaluated protein (54.8%) and decreased glucose (51.6%). 19 patients found tumor cells and were administrated intrathecal chemotherapy (mostly methotrexate; the median cycles were 4), in which 9 turned to be negative. 4 patients received CSF genetic testing and 2 were detected mutation. 60 patients used target therapy. Patients received WBRT with boost (40 Gy in 20 fractions (f) for WBRT and 60Gy in 20 f for boost; 64.8%), focal radiation to LMs (26.2%), WBRT and CSI (50 Gy in 25 f for WBRT and 36 Gy in 20 f for CSI; 9.1%). Response rates of CR, PR and SD were 5.7%, 71.6% and SD 13.6%, respectively. The median follow-up and survival time was 13.5 and 17.6 months, respectively. The 1-year LC, IPFS and OS was 75.2%, 52.9%, and 71.3%, respectively.

Conclusion: Neuroimaging, clinical signs and CSF findings may be prior inspection items for diagnosis of LMs. Early detection with reasonable comprehensive treatment including precise radiotherapy, intrathecal chemotherapy and targeted agents can improve local control and survival time of these patients.

Author Disclosure: S. Yang: None. Y. Ma: None. H. Zhang: None. Q. Liu: None.

Siran Yang, MD

Disclosure:
No relationships to disclose.

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