Cancer Management and Research (2018-12-01)

Helical tomotherapy in patients with leptomeningeal metastases

  • Schiopu SRI,
  • Habl G,
  • Haefner M,
  • Katayama S,
  • Herfarth K,
  • Debus J,
  • Sterzing F

Journal volume & issue
Vol. Volume 11
pp. 401 – 409

Abstract

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Sanziana RI Schiopu,1,2 Gregor Habl,3 Matthias Haefner,2 Sonja Katayama,2 Klaus Herfarth,2,4 Juergen Debus,2,4 Florian Sterzing4,5 1Department of Internal Medicine V, Ludwig-Maximilian University, Munich, Germany; 2Department of Radiation Oncology, Heidelberg University, Heidelberg, Germany; 3Department of Radiation Oncology, Klinikum rechts der Isar, Technical University, Munich, Germany; 4Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; 5Radiation Oncology, Kempten Clinic, Kempten, Germany Purpose: Leptomeningeal metastasis (LM) is an increasingly common complication of late-stage systemic cancer, for which there is no standard treatment. We analyzed outcome and toxicity in patients with LM undergoing craniospinal irradiation via helical tomotherapy (HT-CSI) at our institution. Patients and methods: The charts of 15 patients diagnosed with LM and undergoing HT-CSI between 2006 and 2014 were retrospectively assessed. Main neoplasms included breast cancer, lung cancer, and lymphoma. All patients presented with cranial neuropathy due to LM. Follow-up was performed regularly. Survival analysis was performed by the Kaplan–Meier method, and prognostic factors were tested using the COX-regression model. Results: Median survival by cancer type was 6 (breast cancer), 1 (lung cancer), and 2 months (lymphoma), respectively. Median overall survival and relapse-free survival were calculated to be between 2 and 3 months. Six- and 12-month survival was 30% (95% CI 0.08–0.5) and 20% (95% CI 0.05–0.4), respectively. Symptom palliation occurred in 53% of patients in general, but in 67% of breast cancer patients, in particular. Patients with lung cancer experienced no improvement. Most common acute treatment-related toxicity at different levels were hematological toxicity, multiple cranial neuropathy, fatigue, infections, nausea, and headache. Conclusion: HT-CSI can help meet the challenge of treating patients with LM, especially because it can palliate symptoms and improve neurological functions. One-year survival remains as disappointing as before. Keywords: craniospinal irradiation, radiotherapy, palliative care, neoplastic meningitis, breast cancer

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