Gastric leptomeningeal carcinomatosis: multi-center retrospective analysis of 54 cases.

Department of Internal Medicine, Dong-A University College of Medicine, 3-1 Dongdaeshin-dong, Seo-gu, Busan 602-715, South Korea. .
World Journal of Gastroenterology (Impact Factor: 2.37). 10/2009; 15(40):5086-90.
Source: PubMed


To identify the clinical features and outcomes of infrequently reported leptomeningeal carcinomatosis (LMC) of gastric cancer.
We analyzed 54 cases of cytologically confirmed gastric LMC at four institutions from 1994 to 2007.
The male-to-female ratio was 32:22, and the patients ranged in age from 28 to 78 years (median, 48.5 years). The majority of patients had advanced disease at initial diagnosis of gastric cancer. The clinical or pathologic tumor, node and metastasis stage of the primary gastric cancer was IV in 38 patients (70%). The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 6.3 mo, ranging between 0 and 73.1 mo. Of the initial endoscopic findings for the 45 available patients, 23 (51%) of the patients were Bormann type III and 15 (33%) patients were Bormann type IV. Pathologically, 94% of cases proved to be poorly differentiated adenocarcinomas. Signet ring cell component was also observed in 40% of patients. Headache (85%) and nausea/vomiting (58%) were the most common presenting symptoms of LMC. A gadolinium-enhanced magnetic resonance imaging was conducted in 51 patients. Leptomeningeal enhancement was noted in 45 cases (82%). Intrathecal (IT) chemotherapy was administered to 36 patients-primarily methotrexate alone (61%), but also in combination with hydrocortisone/+/- Ara-C (39%). The median number of IT treatments was 7 (range, 1-18). Concomitant radiotherapy was administered to 18 patients, and concomitant chemotherapy to seven patients. Seventeen patients (46%) achieved cytological negative conversion. Median overall survival duration from the diagnosis of LMC was 6.7 wk (95% CI: 4.3-9.1 wk). In the univariate analysis of survival duration, hemoglobin, IT chemotherapy, and cytological negative conversion showed superior survival duration (P = 0.038, P = 0.010, and P = 0.002, respectively). However, in our multivariate analysis, only cytological negative conversion was predictive of relatively longer survival duration (3.6, 6.7 and 14.6 wk, P = 0.030, RR: 0.415, 95% CI: 0.188-0.918).
Although these patients had a fatal clinical course, cytologic negative conversion by IT chemotherapy may improve survival.

Download full-text


Available from: Sung Yong Oh, Aug 15, 2014
  • Source
    • "The prevalence of LMC in GC is as low as 0.1–0.24% (3,4). Internal auditory canal (IAC) metastasis from GC has rarely been reported (5) and, to the best of our knowledge, IAC metastasis due to LMC has never been reported in GC. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Internal auditory canal (IAC) metastasis due to leptomeningeal carcinomatosis (LMC) from gastric cancer (GC) has rarely been reported. Early manifestation of symptoms, such as hearing loss, vertigo and facial paralysis, in cases of IAC metastasis due to LMC may facilitate the early detection of brain metastasis. To the best of our knowledge, the present study is the first to report IAC metastasis due to LMC in human epidermal growth factor receptor 2 (Her2)-positive GC. This study reports a case of an Her2-positive GC patient with LMC including IAC metastasis, who presented with acute sensorineural hearing loss, ipsilateral facial paralysis and vertigo during trastuzumab containing chemotherapy. The current study also discusses the early diagnosis and management of this complicated condition, demonstrating that clinical suspicion is key for a prompt diagnosis and proper management of LMC including IAC metastasis in Her2-positive GC.
    Full-text · Article · Jul 2014 · Oncology letters
  • Source
    • "The presenting symptoms and signs of LMC are commonly nonspecific and lead to multifocal neurological deficits. In a series of 54 patients with LMC from gastric cancer, headache was most prevalent (85.1%), followed by nausea/vomiting, dizziness, alterations in mental status, seizure, and motor weakness [9]. In our case, the most common symptom was headache, followed by altered mental status and dysarthria/dysphonia. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study is to investigate the clinical features and outcomes of 9 consecutive patients who suffered with leptomeningeal carcinomatosis (LMC) originating from gastric cancer. Between January 1995 and December 2010, we retrospectively reviewed the medical records of 9 patients with gastric LMC who had been treated at St. Vincent's Hospital, The Catholic University of Korea. With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 5 cases had poorly differentiated or signet ring cell histology. TNM stage of the primary gastric cancer was III in 6 patients. The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 9 months. Headache (6 cases), altered mental status (4 cases), and dysarthria (3 cases) were presenting symptoms of LMC. Computed tomography findings were abnormal in 4 of 7 cases, while magnetic resonance imaging revealed abnormality in 4 of 5 cases. Radiation therapy was administered to 5 patients and intrathecal chemotherapy was administered to only 1 patient. Median overall survival duration from the diagnosis of LMC was 3 months. LMC originating from gastric cancer had a fatal clinical course and treatment strategies remain challenging.
    Full-text · Article · Jan 2014 · Annals of Surgical Treatment and Research
  • Source
    • "In addition to bedridden patients and those with no lifespan expanding therapy (see point 5 following), there are three groups of patients in whom survival rates remain marginally low. These include allogeneic BMT recipients with severe graft-versus-host disease (GVHD) who are unresponsive to immunosuppressive therapy [27,61], patients with multiple organ failure related to delayed ICU admission [10], and specific clinical vignettes in patients with solid tumors, such as pulmonary carcinomatous lymphangitis with acute respiratory failure [62], carcinomatous meningitis with coma [63], or bone involvement by extra-hematopoietic cancerous cells and medullar insufficiency [64]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A few decades have passed since intensive care unit (ICU) beds have been available for critically ill patients with cancer. Although the initial reports showed dismal prognosis, recent data suggest that an increased number of patients with solid and hematological malignancies benefit from intensive care support, with dramatically decreased mortality rates. Advances in the management of the underlying malignancies and support of organ dysfunctions have led to survival gains in patients with life-threatening complications from the malignancy itself, as well as infectious and toxic adverse effects related to the oncological treatments. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer. The prognostic significance of certain factors has changed over time. For example, neutropenia or autologous bone marrow transplantation (BMT) have less adverse prognostic implications than two decades ago. Similarly, because hematologists and oncologists select patients for ICU admission based on the characteristics of the malignancy, the underlying malignancy rarely influences short-term survival after ICU admission. Since the recent data do not clearly support the benefit of ICU support to unselected critically ill allogeneic BMT recipients, more outcome research is needed in this subgroup. Because of the overall increased survival that has been reported in critically ill patients with cancer, we outline an easy-to-use and evidence-based ICU admission triage criteria that may help avoid depriving life support to patients with cancer who can benefit. Lastly, we propose a research agenda to address unanswered questions.
    Full-text · Article · Mar 2011 · Annals of Intensive Care
Show more