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Clinical outcome in aggressively treated meningeal carcinomatosis
R Grant1, B Naylor, H S Greenberg
1Department of Neurology, University of Michigan Hospitals, Ann Arbor.
Objective:
To critically evaluate the clinical outcome of patients with cytologically proved meningeal carcinomatosis and to identify factors associated with an improved outcome.
Design:
A consecutive series of patients was identified from a cytopathology data base. The study period was from 1985 to 1990. Case records and results of radiologic investigations were reviewed; all patients were followed up until their deaths.
Setting:
University hospital with a cancer center.
Patients:
Thirty-six consecutive patients with cytologically proved meningeal carcinomatosis. Patients with lymphoma or leukemia were excluded.
Interventions:
External beam radiation therapy, intrathecal chemotherapy via a ventricular catheter, and intravenous chemotherapy.
Main Outcome Measures:
Clinical assessment and survival.
Results:
Symptoms improved in 15% of 33 treated patients. Response to treatment had no clear relationship with the age, site of involvement, or tumor type. Median survival for treated patients was only 9 weeks. Patients who received more than five intrareservoir chemotherapy treatments had a median survival of 23 weeks. Median survival for patients with breast carcinoma who received intravenous chemotherapy was 20 weeks, significantly better than that of patients not receiving intravenous chemotherapy.
Conclusions:
Survival is poor despite aggressive treatment. Intravenous chemotherapy may improve survival in patients with chemoresponsive primary tumors and deserves further study.