[Multidisciplinary treatment of leptomeningeal metastasis in patients with lung adenocarcinoma: the triple modality combination of EGFR-TKI, VP shunt and irradiation].
BACKGROUND
Leptomeningeal metastasis (LM) is a devastating complication of systemic cancers. New therapies that have beneficial effects on primary cancers outside the central nervous system (CNS) have underscored the significance of LM. Intrathecal chemotherapy plus radiation therapy are less effective for LM from lung adenocarcinoma. We retrospectively studied outcomes of patients with LM from lung adenocarcinoma who underwent multidisciplinary treatments in our institute.


METHODS
Four patients with LM from lung adenocarcinoma treated with EGFR-TKI, VP shunt and irradiation. Of those four, two presented with increased intracranial pressure, one with epilepsy, and the other with truncal ataxia. Treatment was indicated when LM was confirmed by MR images or cytology, and Karnofsky Performance Status scale was more than 40%, and life expectancy was more than three months if LM was controlled. EGFR mutation was not examined, because of the unsettled approval of Japanese public health insurance at the time of this study. The patients selected for treatment by EGFR-TKI were all Asian women who had never smoked. Treatment sequence was based on clinical symptoms depending on the individual situation.


RESULTS
The mean time from diagnosis of lung adenocarcinoma to LM onset was 28 (24 to 36) months. Mean survival time from LM diagnosis was 9 months. All patients died of LM. No patients suffered from peritoneal carcinomatosis or infection after VP shunt.


CONCLUSIONS
The triple modality combination of EGFR-TKI, VP shunt and radiation therapy may improve outcomes and symptoms of patients with LM from lung adenocarcinoma.
Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan.
Koichi
K
Mitsuya
Yoko
Y
Nakasu
Yoshihito
Y
Mizokami
Toshiaki
T
Takahashi
Yukiko
Y
Nakamura
Akira
A
Ono
Yoko
Y
Toda
Nobuyuki
N
Yamamoto
Hideyuki
H
Harada
Tetsuo
T
Nishimura
D000230:Adenocarcinoma / Q000201:enzymology / Q000473:pathology / Q000628:therapy*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000201:enzymology / Q000473:pathology / Q000628:therapy*; D055756:Meningeal Carcinomatosis / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011799:Quinazolines / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D017287:Ventriculoperitoneal Shunt / Q000379:methods
D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000077156:Gefitinib