Leptomeningeal metastases--treatment results in 98 consecutive patients

We report 98 consecutive patients with leptomeningeal metastases from lymphoma and other solid tumors. Of 90 who had non-CNS primary tumors, 71 had a life expectancy of at least 2 months from their systemic disease and were treated according to a protocol including radiotherapy to the symptomatic areas of the CNS and chemotherapeutic agents (usually MTX) administered into the CSF. Eight patients with meningeal spread from CNS tumors received craniospinal irradiation and/or systemic or intra-CSF chemotherapy. Of those treated according to the protocol, 30 had lymphoma, 25 of whom achieved a CR and 4 a PR; 27 had breast carcinoma, 9 of whom achieved a CR and 6 a PR; 14 had other solid tumors, 7 of whom achieved a CR and 2 a PR. Median survival was 8 months (range 1 to 87+) in patients with lymphoma and 3 months (range 1 to 40) in breast carcinoma patients. Long-term survivors were seen in these groups. Treatment complications occurred in 30% of patients, resulting in 4 deaths. The indications for aggressive therapy of leptomeningeal metastases and means to reduce its toxicity are discussed.