title: Prognostic factors and clinical outcome of patients with lung adenocarcinoma with carcinomatous meningitis.
abstract: BACKGROUND
  In recent years, the incidence of carcinomatous meningitis (CM) in lung adenocarcinoma has been rising. However, it remains unclear which treatment strategies improve the outcome of these patients.
  
  
  METHODS
  We retrospectively reviewed data for 67 lung adenocarcinoma patients diagnosed with CM between September 2002 and March 2011 in order to identify factors which would improve prognosis.
  
  
  RESULTS
  In multivariate analysis, the female gender, a good performance status (PS) 0-2 and the mutant epidermal growth factor receptor (EGFR) gene were identified as factors associated with a favorable prognosis. The survival time was significantly prolonged for patients treated with EGFR-tyrosine kinase inhibitors (TKIs) (240 vs. 57 days, p<0.0001) and for patients who underwent radiotherapy of the central nervous system (CNS) (201 vs. 76 days, p=0.0038) after diagnosis of CM. The median survival time (MST) of patients treated with gefitinib before diagnosis of CM and with erlotinib after diagnosis was significantly longer than the MST of patients treated with gefitinib both before and after the diagnosis of CM (407 vs. 205 days, p=0.0015). Patients treated with both radiotherapy for CNS and EGFR-TKI had longer survival compared to patients without radiotherapy for the CNS (379 vs. 122 days, p=0.032).
  
  
  CONCLUSIONS
  EGFR-TKI combined with radiotherapy may be a therapeutic approach capable of improving the prognosis of patients with lung adenocarcinoma with CM harboring the EGFR gene mutation.
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-chou, Suntou-gun, Shizuoka, 411-8777, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Asuka
authors.initials: A
authors.lastname: Tsuya
authors.forename: Tateaki
authors.initials: T
authors.lastname: Naito
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kenmotsu
authors.forename: Akira
authors.initials: A
authors.lastname: Ono
authors.forename: Takehito
authors.initials: T
authors.lastname: Shukuya
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Murakami
authors.forename: Hideaki
authors.initials: H
authors.lastname: Harada
authors.forename: Reiko
authors.initials: R
authors.lastname: Watanabe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Endo
authors.forename: Koichi
authors.initials: K
authors.lastname: Mitsuya
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008581:Meningitis / Q000209:etiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009154:Mutation; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors