J Korean Neurosurg Soc.  2012 Sep;52(3):193-199.

Incidence and Risk Factors for Leptomeningeal Carcinomatosis in Breast Cancer Patients with Parenchymal Brain Metastases

• Jung JM
• Kim S
• Joo J
• Shin KH
• Gwak HS
• Lee SH

Abstract

OBJECTIVE
The objective of study is to evaluate the incidence of leptomeningeal carcinomatosis (LMC) in breast cancer patients with parenchymal brain metastases (PBM) and clinical risk factors for the development of LMC.
METHODS
We retrospectively analyzed 27 patients who had undergone surgical resection (SR) and 156 patients with whole brain radiation therapy (WBRT) as an initial treatment for their PBM from breast cancer in our institution and compared the difference of incidence of LMC according to clinical factors. The diagnosis of LMC was made by cerebrospinal fluid cytology and/or magnetic resonance imaging.
RESULTS
A total of 27 patients (14%) in the study population developed LMC at a median of 6.0 months (range, 1.0-50). Ten of 27 patients (37%) developed LMC after SR, whereas 17 of 156 (11%) patients who received WBRT were diagnosed with LMC after the index procedure. The incidence of LMC was significantly higher in the SR group compared with the WBRT group and the hazard ratio was 2.95 (95% confidence interval; 1.33-6.54, p<0.01). Three additional factors were identified in the multivariable analysis : the younger age group (<40 years old), the progressing systemic disease showed significantly increased incidence of LMC, whereas the adjuvant chemotherapy reduce the incidence.
CONCLUSION
There is an increased risk of LMC after SR for PBM from breast cancer compared with WBRT. The young age (<40) and systemic burden of cancer in terms of progressing systemic disease without adjuvant chemotherapy could be additional risk factors for the development of LMC.

Keyword

Brain metastasis; Breast cancer; Leptomeningeal carcinomatosis; Surgery; Whole brain radiation therapy

MeSH Terms

Brain
Breast
Breast Neoplasms
Chemotherapy, Adjuvant
Humans
Incidence
Magnetic Resonance Spectroscopy
Meningeal Carcinomatosis
Neoplasm Metastasis
Retrospective Studies
Risk Factors
Streptothricins
Streptothricins

Figure

• 

  Fig. 1 Kaplan-Meier curve for time to development of LMC after treatment of the parenchymal brain metastases plotted for 183 patients in our study. Y-axis represents the proportion of patients without LMC at each follow-up time at the X-axis. 27 patients developed LMC (14%) during the follow-up. LMC : leptomeningeal carcinomatosis.

• 

  Fig. 2 Kaplan-Meier curves for time to development of LMC after treatment of the parenchymal brain metastases according to index procedure. Y-axis represents the proportion of patients without LMC at each follow-up time at the X-axis. Patients in the surgical resection (n=27) conferred greater risk for developing LMC compared to those in the WBRT (n=156) (HR estimated by the Cox proportional hazard model=2.95, 95% confidence interval, 1.33-6.54, p=0.008). LMC : leptomeningeal carcinomatosis, WBRT : whole brain radiation therapy, HR : hazard ratio.

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