PMID- 25404928
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141118
LR  - 20220408
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 5
DP  - 2014
TI  - Leptomeningeal metastases in high-grade adult glioma: development, diagnosis, 
      management, and outcomes in a series of 34 patients.
PG  - 220
LID - 10.3389/fneur.2014.00220 [doi]
LID - 220
AB  - METHODS: Leptomeningeal metastases (LM) in the setting of glioma have often been 
      thought to carry a particularly poor prognosis. We sought to better characterize 
      this phenomenon through a review of patients with glioma seen in our institution 
      over the preceding 10 years. We focus here on 34 cases with LM due to grade III 
      or IV glioma. Over the period in question, we estimate a prevalence of almost 4% 
      in those affected by grade IV tumors. RESULTS: Leptomeningeal spread was present 
      at the time of initial diagnosis in 4 patients. Among the others, LM occurred at 
      the time of first progression of disease in 17. The median time to development of 
      LM (excluding those where it was present at initial diagnosis) was 16.4 months 
      [95% confidence interval (CI) 8.2-43.9]. The median time to further progression 
      of disease following LM was 4.9 months (95% CI 3.1-6.9). Twenty-five patients 
      were known to have died at the time of writing. Thus, median overall survival 
      (OS) was 10.2 months (95% CI 8.8-14.7) following LM. At the time of diagnosis of 
      LM, some form of treatment (chemotherapy and/or radiation vs. no treatment) 
      increased OS (median 11.7 vs. 3.3 months, p < 0.001 by log-rank test). Use of 
      radiation therapy (vs. no radiation) also increased OS, although the effect was 
      more modest (7.8 vs. 16.8 months, p = 0.07). Higher Karnofsky Performance Status 
      (KPS) at the time of diagnosis of LM was associated with OS (p = 0.007, median OS 
      for KPS >/=90 19 months vs. 7.8 for KPS <90). In a two-variable model incorporating 
      the use any treatment (vs. none) and KPS, the latter tended to be a more 
      significant predictor of survival (p = 0.22 vs. p = 0.06 by likelihood-ratio 
      test). This was also true for radiation (vs. none) and KPS (p = 0.27 vs. 
      p = 0.02). No significant benefit could be demonstrated for the use of 
      chemotherapy considered alone, either systemic or intrathecal. It should be noted 
      that 4 of 9 patients receiving intrathecal chemotherapy had a 
      ventriculo-peritoneal shunt in place during these injections, which may have 
      reduced its effectiveness. CONCLUSION: Overall, treatment appears to improve 
      outcomes. We favor maximal treatment, as tolerated, particularly with a KPS of 
      >/=70. Such treatment would typically include radiation to the maximum tolerated 
      dose, concurrent, and adjuvant chemotherapy (preferably with an alkyating agent), 
      in addition to intrathecal treatment.
FAU - Dardis, Christopher
AU  - Dardis C
AD  - Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA.
FAU - Milton, Kelly
AU  - Milton K
AD  - Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA.
FAU - Ashby, Lynn
AU  - Ashby L
AD  - Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA.
FAU - Shapiro, William
AU  - Shapiro W
AD  - Department of Neurology, Barrow Neurological Institute , Phoenix, AZ , USA.
LA  - eng
PT  - Journal Article
DEP - 20141103
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC4217477
OTO - NOTNLM
OT  - Ommaya
OT  - glioblastoma multiforme
OT  - glioma
OT  - intrathecal
OT  - leptomeningeal
OT  - metastases
EDAT- 2014/11/19 06:00
MHDA- 2014/11/19 06:01
PMCR- 2014/11/03
CRDT- 2014/11/19 06:00
PHST- 2014/04/22 00:00 [received]
PHST- 2014/10/09 00:00 [accepted]
PHST- 2014/11/19 06:00 [entrez]
PHST- 2014/11/19 06:00 [pubmed]
PHST- 2014/11/19 06:01 [medline]
PHST- 2014/11/03 00:00 [pmc-release]
AID - 10.3389/fneur.2014.00220 [doi]
PST - epublish
SO  - Front Neurol. 2014 Nov 3;5:220. doi: 10.3389/fneur.2014.00220. eCollection 2014.