title: Carcinomatous meningitis in patients with breast cancer. An aggressive disease variant.
abstract: BACKGROUND
  Carcinomatous meningitis is a rare and often devastating complication in patients with breast cancer, and the treatment is controversial.
  
  
  METHODS
  A retrospective analysis of 35 patients with carcinomatous meningitis from breast cancer was performed to define the biology of the disease and to guide treatment.
  
  
  RESULTS
  An aggressive variant of breast cancer was revealed: meningeal metastasis complicates less than 3.5% of cases of metastatic breast carcinoma. Sixty-seven percent of these patients had tumors that were lobular or combined lobular/ductal histology; the median intervals from primary treatment to disease recurrence and from recurrence to death were 10.9 and 15 months, respectively. The median survival after diagnosis of carcinomatous meningitis was 77 days. The most significant prognostic factor was the Karnofsky performance status (KP) at presentation of meningeal disease. Patients with a KP greater or equal to 70 survived a median of 313 days, whereas those with a KP of 60 or less survived for a median of 36 days (P = 0.0002). In addition, there was a trend suggesting that the response 2 weeks after treatment was initiated, correlated with survival.
  
  
  CONCLUSIONS
  Carcinomatous meningitis from breast carcinoma is an aggressive metastatic complication with a poor prognosis. The authors suggest that patients with a poor KP (< 70) should be treated symptomatically and those with a good KP (> or = 70) should receive more aggressive treatment. The patients' survival in this study compared well with other reports, and yet, only one patient was treated with intraventricular chemotherapy. Therefore, these data question the superiority of intraventricular treatment versus other modalities.
authors.affiliation: Department of Medical Oncology, Christie Hospital National Health Service Trust, Withington, Manchester, United Kingdom.
authors.forename: G C
authors.initials: GC
authors.lastname: Jayson
authors.forename: A
authors.initials: A
authors.lastname: Howell
authors.forename: M
authors.initials: M
authors.lastname: Harris
authors.forename: G
authors.initials: G
authors.lastname: Morgenstern
authors.forename: J
authors.initials: J
authors.lastname: Chang
authors.forename: W D
authors.initials: WD
authors.lastname: Ryder
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D008581:Meningitis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis