title: Meningeal carcinomatosis in breast cancer: prognostic factors and outcome.
abstract: Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27-76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03-90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients.
authors.affiliation: Department of Medical Oncology, Hospital A. C. Camargo, Rua Prof. Antônio Prudente, 211, CEP 01509-900, Liberdade, Sao Paulo, Brazil. carla.rameri@bol.com.br
authors.forename: Carla Rameri Alexandre Silva
authors.initials: CR
authors.lastname: de Azevedo
authors.forename: Marcelo Rocha Sousa
authors.initials: MR
authors.lastname: Cruz
authors.forename: Ludmilla Thomé Domingos
authors.initials: LT
authors.lastname: Chinen
authors.forename: Stela Verzinhasse
authors.initials: SV
authors.lastname: Peres
authors.forename: Marcos Aurélio
authors.initials: MA
authors.lastname: Peterlevitz
authors.forename: Artur Eugênio
authors.initials: AE
authors.lastname: de Azevedo Pereira
authors.forename: Marcello Ferretti
authors.initials: MF
authors.lastname: Fanelli
authors.forename: Daniel Luiz
authors.initials: DL
authors.lastname: Gimenes
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D055756:Meningeal Carcinomatosis / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents