title: Leptomeningeal metastasis: Clinical experience of 519 cases.
abstract: BACKGROUND
  Diagnosis of leptomeningeal metastasis (LM) has become increasingly common because of enhanced detection via routine use of magnetic resonance imaging (MRI) and longer survival of patients by better systemic control. We investigated clinical features and analyzed potential prognostic factors in a large cohort of patients with LM.
  
  
  METHODS
  The clinical features of LM developing from systemic cancers were analyzed retrospectively in patients at the National Cancer Center during 2005-2014.
  
  
  RESULTS
  A total of 519 patients were enrolled; 497 had solid, 19 had hematopoietic tumors and 3 had tumors of unknown etiology. Among the solid tumors, the most common primary tumor was lung cancer (334 patients), followed by breast cancer (96) and gastrointestinal cancer (39). Median age at onset was 56 years, and the median Karnofsky performance status (KPS) was 60. Thirty-five percent of patients were diagnosed by MRI alone, 22% by cerebrospinal fluid (CSF) cytology alone, and 42% by both. Treatment included chemotherapy alone in 45%, radiation therapy alone in 10%, and both in 17%; 28% received supportive care alone. Median overall survival was 3 months. KPS ≥70, CSF protein level ≤50 mg/dl at the diagnosis of LM, and active treatment were associated independently with longer overall survival. Upon subgroup analysis of lung cancer patients, non-small cell lung cancer was a favorable prognostic factor for overall survival.
  
  
  CONCLUSIONS
  Despite improved diagnosis via MRI and vigorous therapy, most patients with LM had poor outcomes. However, patients with a high KPS or normal CSF protein levels had favorable prognoses upon active treatment.
authors: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: jacksy12@naver.com.
authors: Jae-Won
authors: JW
authors: Hyun
authors: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: timeisnear@hanmail.net.
authors: In Hye
authors: IH
authors: Jeong
authors: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: joungaeran@paran.com.
authors: AeRan
authors: A
authors: Joung
authors: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: deresa66@hotmail.com.
authors: Hyo Jin
authors: HJ
authors: Cho
authors: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: herena20@hanmail.net.
authors: Su-Hyun
authors: SH
authors: Kim
authors: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: hojinkim@ncc.re.kr.
authors: Ho Jin
authors: HJ
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D055756:Meningeal Carcinomatosis / Q000134:cerebrospinal fluid / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: CSF; Cancer; Leptomeningeal metastasis; MRI; Prognosis; Survival