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Thirty-one(23%)of 137 patients treated for leptomeningeal metastases(LM) achieved a sustained off therapy response of at least 6 months duration following treatment by a standard protocol.Of the 31 patients,equal distribution was found among various tumors:lymphoma,13/44(29%);breast carcinoma(10/51(20%);and other tumors,8/42(19%).Neuroimaging of the neuraxis disclosed subarachnoid deposits in 70%with unexpected findings at 55%.At withdrawal of therapy,all 13 patients with lymphomas had achieved a complete response,and for those with the other tumors,61%had a partial response.Off-therapy release was unrelated to the type of attained response and occurred in nine patients(29%)after a median time of 12 months.Five patients obtained a second prolonged response,mainly by systemic therapy.All eight patients who received only systemic therapy for their LM responded to the treatment,four with a complete response.All others received both systemic and intra-CSF treatment and maintained a systemic response.Delayed complications occurred in 58%,with leukoencephalopathy equally affecting patients exposed and patients not exposed to cranial irradiation.The median survival of the whole group was 23 months.We conclude that in LM(lymphomas excluded),a partial response is compatible with a prolonged off-therapy response.Since LM may respond to systemic treatment,the role of intra-CSF therapy,with its associated complications,deserves a prospective reevaluation. |
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chemotherapy,CNS treatment and complications with
meningitis,carcinomatous
radiation therapy,CNS treatment and complications with
treatment of neurologic disorder
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