Breast cancer leptomeningeal metastasis--the role of multimodality treatment.
OBJECTIVE
The aim of the study was to assess the efficacy of multimodality treatment of patients with Leptomeningeal metastasis (LM) and to establish which method of treatment has the greatest positive impact on survival.


METHODS
Clinical material included 67 consecutive breast cancer patients with LM treated at the Cancer Center in Warsaw between the years 2000 and 2005. Intrathecal chemotherapy was given to 57 pts (85%), intravenous chemotherapy to 41 pts (61%), whole brain radiotherapy to 33 pts (49%) and radiotherapy to the spinal leptomeninges to 10 (15%). For 27 pts (40%) three methods of treatment were used. Univariate and multivariate analyses were used to evaluate the impact of the particular method of treatment on survival and to assess the efficacy of combined modalities.


RESULTS
Clinical response was achieved in 49 pts (76%). Median survival calculated from the diagnosis of LM was 16 weeks (range 1-402 weeks). Univariate analysis showed positive impact of systemic intravenous chemotherapy (P = 0.0009), intrathecal chemotherapy (P = 0.008) and whole brain radiotherapy (P = 0.004) on survival. The results of Cox multivariate analysis have shown systemic chemotherapy (P < 0.001) and intrathecal chemotherapy (P = 0.001) to be significant.


CONCLUSIONS
Intravenous chemotherapy and, independently, intrathecal chemotherapy improve survival in breast cancer patients with LM. Radiotherapy has a positive impact on the quality of life due to the alleviation of neurological symptoms. The role of radiotherapy in prolonging survival is questionable.
Rudnicka
Halina
H
Department of Breast Cancer, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Roentgen 5 str., 02-781, Warsaw, Poland.
Niwińska
Anna
A
Murawska
Magdalena
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D003131:Combined Modality Therapy / Q000379:methods; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D006801:Humans; D007262:Infusions, Intravenous; D007278:Injections, Spinal; D053208:Kaplan-Meier Estimate; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011878:Radiotherapy / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D003907:Dexamethasone; D008727:Methotrexate