Treatment and prognosis of leptomeningeal disease secondary to metastatic breast cancer: A single-centre experience

摘要: Abstract Purpose Leptomeningeal disease (LMD) is an uncommon complication of advanced breast cancer. The prognosis poor, and although radiotherapy (RT), systemic intra-thecal (IT) chemotherapy are accepted treatment modalities, efficacy data limited. This study was designed to evaluate potential predictors survival in this patient group. Methods Breast cancer patients with LMD diagnosed by MRI a 10-year period (2004–2014) were identified from electronic records. PFS OS estimates calculated using Kaplan-Meier method, planned sub-group analysis modality. Cox regression employed identify significant prognostic variables. Results We 182 eligible patients; all female, median age at diagnosis 52.5 years (range 23–80). Ninety (49.5%) ER positive/HER2 negative; 48 (26.4%) HER2 positive, 27 (14.8%) triple negative. status unknown 17 (9.3%). Initial management most commonly whole or partial brain RT 62 (34.1%), therapy 45 (24.7%) supportive care alone 37 (20.3%). Fourteen (7.7%) underwent IT chemotherapy, whom two also received trastuzumab. From LMD, the 3.9 months (95%CI 3.2–5.0) 5.4 4.2–6.6). Patients treated had longest (median 8.8 months, 95%CI 5.5–11.1), compared RT; 6.1 4.2–7.9 months), therapy; 2.9 1.2–5.8) care; 1.7 0.9–3.0). On multivariable analysis, negative histology, concomitant metastases, involving both spinal cord associated poor OS. Conclusions metastases affecting spine have poorest prognosis. Clinical trials more effective treatments for these urgently needed.