Helical tomotherapy in patients with leptomeningeal metastases
Received 27 August 2018
Accepted for publication 19 November 2018
Published 31 December 2018 Volume 2019:11 Pages 401—409
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Lu-Zhe Sun
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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