Gastric leptomeningeal carcinomatosis: multi-center retrospective analysis of 54 cases.
OBJECTIVE
To identify the clinical features and outcomes of infrequently reported leptomeningeal carcinomatosis (LMC) of gastric cancer.


METHODS
We analyzed 54 cases of cytologically confirmed gastric LMC at four institutions from 1994 to 2007.


RESULTS
The male-to-female ratio was 32:22, and the patients ranged in age from 28 to 78 years (median, 48.5 years). The majority of patients had advanced disease at initial diagnosis of gastric cancer. The clinical or pathologic tumor, node and metastasis stage of the primary gastric cancer was IV in 38 patients (70%). The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 6.3 mo, ranging between 0 and 73.1 mo. Of the initial endoscopic findings for the 45 available patients, 23 (51%) of the patients were Bormann type III and 15 (33%) patients were Bormann type IV. Pathologically, 94% of cases proved to be poorly differentiated adenocarcinomas. Signet ring cell component was also observed in 40% of patients. Headache (85%) and nausea/vomiting (58%) were the most common presenting symptoms of LMC. A gadolinium-enhanced magnetic resonance imaging was conducted in 51 patients. Leptomeningeal enhancement was noted in 45 cases (82%). Intrathecal (IT) chemotherapy was administered to 36 patients-primarily methotrexate alone (61%), but also in combination with hydrocortisone/+/- Ara-C (39%). The median number of IT treatments was 7 (range, 1-18). Concomitant radiotherapy was administered to 18 patients, and concomitant chemotherapy to seven patients. Seventeen patients (46%) achieved cytological negative conversion. Median overall survival duration from the diagnosis of LMC was 6.7 wk (95% CI: 4.3-9.1 wk). In the univariate analysis of survival duration, hemoglobin, IT chemotherapy, and cytological negative conversion showed superior survival duration (P = 0.038, P = 0.010, and P = 0.002, respectively). However, in our multivariate analysis, only cytological negative conversion was predictive of relatively longer survival duration (3.6, 6.7 and 14.6 wk, P = 0.030, RR: 0.415, 95% CI: 0.188-0.918).


CONCLUSIONS
Although these patients had a fatal clinical course, cytologic negative conversion by IT chemotherapy may improve survival.
Oh
Sung Yong
SY
Department of Internal Medicine, Dong-A University College of Medicine, 3-1 Dongdaeshin-dong, Seo-gu, Busan 602-715, South Korea. kimhj@dau.ac.kr.
Lee
Su-Jin
SJ
Lee
Jeeyun
J
Lee
Suee
S
Kim
Sung-Hyun
SH
Kwon
Hyuk-Chan
HC
Lee
Gyeong-Won
GW
Kang
Jung-Hun
JH
Hwang
In-Gyu
IG
Jang
Joung-Soon
JS
Lim
Ho-Yeong
HY
Park
Young-Suk
YS
Kang
Won-Ki
WK
Kim
Hyo-Jin
HJ
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D055756:Meningeal Carcinomatosis / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome