title: Leptomeningeal metastasis from prostate cancer.
abstract: OBJECTIVE
  Metastatic prostate carcinoma commonly involves bones and extrapelvic lymph nodes, with occasional visceral deposits. Central nervous system involvement is unusual and particularly the occurrence of leptomeningeal metastasis (LM) is extremely rare, with few cases described in the medical literature. The clinical presentation is characterized by multifocal neurological deficit and the prognosis is generally dismal, with survival ranging between 3 and 6 months. We report on a patient affected by LM due to prostate cancer who was treated with a combined-modality approach consisting of sequential chemotherapy and radiotherapy.
  
  
  METHODS
  A 70-year-old man was referred to our group for cognitive mental disorder, left-sided frontal headache and nausea; the patient had a previous history of metastatic prostate cancer. LM was diagnosed neuroradiologically with brain MRI and evidence of a detectable level of PSA in the cerebrospinal fluid. He was treated with docetaxel and prednisone for 3 cycles followed by external beam radiotherapy (EBRT) to the whole brain to a total dose of 30 Gy in 10 fractions with a simultaneous integrated boost to the macroscopic disease (total dose of 35 Gy in 10 fractions). No acute toxicity was observed.
  
  
  RESULTS
  A substantial clinical response was obtained after EBRT with neurological improvement and radiologically stable disease at post-treatment imaging until 10 weeks after radiation. The patient died of sudden general condition deterioration 3 months after EBRT.
  
  
  CONCLUSIONS
  Since LM derived from prostate cancer is likely to become a more common clinical event, such patients would need to be included in clinical trials evaluating new therapeutic approaches, considering that the current treatment strategies have been shown to be rather ineffective.
authors.affiliation: Department of Radiation Oncology, ASL TO4, Ivrea Community Hospital, Ivrea, Italy. domecante@yahoo.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Cante
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.forename: Piera
authors.initials: P
authors.lastname: Sciacero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Girelli
authors.forename: Valeria
authors.initials: V
authors.lastname: Casanova Borca
authors.forename: Massimo
authors.initials: M
authors.lastname: Pasquino
authors.forename: Fernanda
authors.initials: F
authors.lastname: Migliaccio
authors.forename: Santi
authors.initials: S
authors.lastname: Tofani
authors.forename: Lucia
authors.initials: L
authors.lastname: Grassi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Marra
authors.forename: Franca
authors.initials: F
authors.lastname: Ozzello
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: La Porta
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000134:cerebrospinal fluid*; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003072:Cognition Disorders / Q000209:etiology; D003907:Dexamethasone / Q000008:administration & dosage; D000077143:Docetaxel; D019583:Dose Fractionation, Radiation; D017809:Fatal Outcome; D006261:Headache / Q000209:etiology; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary* / Q000628:therapy*; D009325:Nausea / Q000209:etiology; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D017430:Prostate-Specific Antigen / Q000134:cerebrospinal fluid*; D011471:Prostatic Neoplasms / Q000473:pathology*; D018714:Radiotherapy, Adjuvant; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D043823:Taxoids; D000077143:Docetaxel; D003907:Dexamethasone; D017430:Prostate-Specific Antigen; D011241:Prednisone