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Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumors

Behandlungsergebnisse nach alleiniger Ganzhirnbestrahlung bei intrakranieller Meningeosis carcinomatosa solider Tumoren

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Abstract

Background

The purpose of the present study was to investigate outcome after whole brain radiotherapy (WBRT) alone as a palliative treatment without concomitant chemotherapy for intracranial leptomeningeal carcinomatosis (LMC).

Patients and methods

Overall survival and treatment response were retrospectively analyzed in 27 consecutive patients with LMC from breast and lung cancer. All patients had evidence of intracranial manifestations of LMC. Seven potential prognostic factors were evaluated.

Results

Median overall survival (OS) for the entire group was 8.1 weeks. OS rates after 6 and 12 months were 26% and 15%, respectively. Improvement of neurological deficits was observed in 3 patients. In 3 of 4 patients with follow-up MRI studies, a decreased size of contrast-enhanced lesions was observed. Prognostic factors for improved OS on univariate analysis were absence of cranial nerve dysfunction, Karnofsky Performance Score (KPS) > 60%, and time interval > 35 months between the initial diagnosis of malignant disease and development of LMC. On multivariate analysis, absence of cranial nerve dysfunction remained the only significant prognosticator for OS (median 3.7 vs. 19.4 weeks, p < 0.001).

Conclusion

WBRT alone is an effective palliative treatment for patients unfit/unsuitable for chemotherapy and low performance status suffering from intracranial LMC. However, prognostic factors should be considered in order to identify patients who are likely to benefit from WBRT.

Zusammenfassung

Hintergrund

Die vorliegende Studie verfolgt das Ziel, den Stellenwert der alleinigen Ganzhirnbestrahlung (WBRT) ohne simultane Chemotherapie als palliative Therapiemaßnahme der intrakraniellen Leptomeningeosis carcinomatosa (LMC) zu evaluieren.

Patienten und Methodik

27 konsekutive Patienten mit einer LMC solider Tumoren (Brustkrebs, Bronchialkarzinom), die mit alleiniger WBRT behandelt wurden, sind retrospektiv hinsichtlich Gesamtüberleben und Therapieansprechen untersucht worden. Alle Patienten wiesen einen intrakraniellen Befall der Hirnhäute auf. Darüber hinaus wurden 7 potentielle prognostische Faktoren analysiert.

Ergebnisse

Das mediane Gesamtüberleben lag bei 8,1 Wochen, das Gesamtüberleben nach 6 und 12 Monaten bei 26% bzw. 15%. Eine Besserung neurologischer Symptome ergab sich bei 3 Patienten. Bei 3 von 4 Patienten, für die eine MRT-Verlaufsbildgebung vorlag, zeigte sich eine deutliche Größenregredienz kontrastmittelaufnehmender Befunde. Prognostische Faktoren für ein verbessertes Gesamtüberleben in der univariaten Analyse waren das Fehlen von Hirnnervenausfällen, ein KPS  > 60% und ein Zeitintervall  > 35 Monate zwischen Primärdiagnose und Entwicklung der LMC. In der multivariaten Analyse verblieb als Prädiktor für ein besseres Gesamtüberleben das Fehlen von Hirnnervenausfällen. Das mediane Gesamtüberleben lag bei 3,7 vs. 19,4 Wochen (p < 0,001).

Schlussfolgerung

Die alleinige WBRT ist eine effektive Behandlungsoption für Patienten mit intrakranieller LMC, die nicht geeignet für eine Chemotherapie sind und einen eingeschränkten Allgemeinzustand vorweisen. Prognosefaktoren sollten in der Therapieentscheidung berücksichtigt werden, um Patienten, die wahrscheinlich von der WBRT profitieren, zu identifizieren.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    C. Gani, A.C. Müller, F. Eckert, C. Schroeder, M. Bamberg & B. Berger

  2. Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany

    B. Bender

  3. Department of Neuropathology, University of Tübingen, Tübingen, Germany

    G. Pantazis

Authors
  1. C. Gani
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  2. A.C. Müller
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  3. F. Eckert
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  4. C. Schroeder
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  5. B. Bender
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  6. G. Pantazis
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  7. M. Bamberg
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  8. B. Berger
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Corresponding author

Correspondence to F. Eckert.

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The first two authors contributed equally to the study.

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Gani, C., Müller, A., Eckert, F. et al. Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumors. Strahlenther Onkol 188, 148–153 (2012). https://doi.org/10.1007/s00066-011-0025-8

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  • DOI: https://doi.org/10.1007/s00066-011-0025-8

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