Leptomeningeal Gliomatosis: A Single Institution Study of 31 Patients

Anticancer Res. 2019 Feb;39(2):1035-1041. doi: 10.21873/anticanres.13210.

Abstract

Background/aim: Secondary leptomeningeal gliomatosis (LG) is a rare and severe progression pattern of glioma. Our objective was to evaluate the characteristics and outcome of patients with LG.

Patients and methods: We retrospectively reviewed 31 patients diagnosed with secondary LG. At the time of LG diagnosis, the median age of patients was 45 years. The histological grade was IV in 20 patients and II to III in 11 patients. As a first-line of therapy for LG, 22 patients received an oncological treatment: i) BCNU-temozolomide (TMZ) (n=15), ii) other type of chemotherapy (n=7), and iii) no treatment (supportive care) (n=9).

Results: Following LG diagnosis, the median progression-free survival (PFS) and overall survival (OS) were 1.8 months [95% confidence interval (CI)=0.9-2.7] and 2.1 months (95%CI=1.3-3), respectively. The univariate analyses showed an improved OS with age of less than 45 years (p<0.001), a prolonged interval from the initial glioma diagnosis (IGD) to LG diagnosis (p=0.003), BCNU-TMZ as the preferred first-line treatment for LG out of the three options (p=0.008), and Karnofsky performance status (KPS) ≥70 (p=0.012). Prolonged interval from IGD to LG diagnosis (HR=5.839) and BCNU-TMZ as the chosen first-line treatment for LG (HR=6.635) remained significant in the multivariate analyses as well. Among the 22 treated patients, the median OS was significantly higher (p=0.008) with the BCNU-TMZ treatment (5.7 months; 95%CI=4.2-7.1), compared to other types of treatment offered (2 months; 95%CI=1.1-2.9).

Conclusion: The time interval from the IGD to the LG diagnosis is a potential prognostic factor for LG. BCNU-TMZ may be a therapeutic option in the present setting.

Keywords: BCNU; Glioma; leptomeningeal gliomatosis; prognostic factors; temozolomide.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Brain Neoplasms / complications*
  • Carmustine / administration & dosage
  • Carmustine / therapeutic use
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Glioma / complications*
  • Humans
  • Karnofsky Performance Status
  • Male
  • Meningeal Neoplasms / complications*
  • Meningeal Neoplasms / mortality
  • Meningeal Neoplasms / therapy*
  • Middle Aged
  • Multivariate Analysis
  • Neoplasms, Neuroepithelial / complications*
  • Neoplasms, Neuroepithelial / mortality
  • Neoplasms, Neuroepithelial / therapy*
  • Prognosis
  • Retrospective Studies
  • Temozolomide / administration & dosage
  • Temozolomide / therapeutic use
  • Treatment Outcome
  • Young Adult

Substances

  • Carmustine
  • Temozolomide