Remedy and prognosis of leptomeningeal illness secondary to metastatic breast most cancers: A single-centre expertise.
Breast. 2017 Dec;36:54-59
Authors: Kingston B, Kayhanian H, Brooks C, Cox N, Chaabouni N, Redana S, Kalaitzaki E, Smith I, O’Brien M, Johnston S, Parton M, Noble J, Stanway S, Ring A, Turner N, Okines A
PURPOSE: Leptomeningeal illness (LMD) is an unusual complication of superior breast most cancers. The prognosis is poor, and though radiotherapy (RT), systemic and intra-thecal (IT) chemotherapy are accepted therapy modalities, efficacy knowledge are restricted. This examine was designed to guage potential predictors of survival on this affected person group.
METHODS: Breast most cancers sufferers with LMD recognized by MRI in a 10-year interval (2004-2014) had been recognized from digital affected person data. PFS and OS estimates had been calculated utilizing Kaplan-Meier methodology, with deliberate sub-group evaluation by therapy modality. Cox regression was employed to establish important prognostic variables.
RESULTS: We recognized 182 eligible sufferers; all feminine, median age at LMD analysis 52.5 years (vary 23-80). Ninety sufferers (49.5%) had been ER constructive/HER2 detrimental; 48 (26.four%) had been HER2 constructive, and 27 (14.eight%) had been triple detrimental. HER2 standing was unknown in 17 (9.Three%). Preliminary administration of LMD was mostly entire or partial mind RT in 62 (34.1%), systemic remedy in 45 (24.7%) or supportive care alone in 37 (20.Three%). Fourteen sufferers (7.7%) underwent IT chemotherapy, of whom two additionally acquired IT trastuzumab. From analysis of LMD, the median PFS was Three.9 months (95%CI Three.2-5.zero) and median OS was 5.four months (95%CI four.2-6.6). Sufferers handled with systemic remedy had the longest OS (median eight.eight months, 95%CI 5.5-11.1), in comparison with RT; 6.1 months (95%CI four.2-7.9 months), IT remedy; 2.9 months (95%CI 1.2-5.eight) and supportive care; 1.7 months (95%CI zero.9-Three.zero). On multivariable evaluation, triple detrimental histology, concomitant mind metastases, and LMD involving each the mind and spinal wire had been related to poor OS.
CONCLUSIONS: Breast most cancers sufferers with triple detrimental LMD, concomitant mind metastases or LMD affecting each the backbone and mind have the poorest prognosis. Scientific trials to establish simpler remedies for these sufferers are urgently wanted.
PMID: 28968585 [PubMed – indexed for MEDLINE]