Outcome and prognostic factors following palliative craniospinal irradiation for leptomeningeal carcinomatosis
| Autor: | Sebastian Adeberg, Denise Bernhardt, Sarah Löw, Karina Böhm, Jürgen Debus, Angela Paul, Rami A El Shafie, Dorothea Weber, Fabian Schlaich, Klaus Herfarth, Juliane Hörner-Rieber, Sonja Katayama, Matthias F. Haefner, Florian Sterzing, Stefan Rieken, Kristin Lang |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Univariate analysis medicine.medical_specialty Proportional hazards model business.industry medicine.medical_treatment Common Terminology Criteria for Adverse Events medicine.disease Tomotherapy Craniospinal Irradiation Radiation therapy 03 medical and health sciences 030104 developmental biology 0302 clinical medicine Breast cancer Oncology 030220 oncology & carcinogenesis Medicine Radiology business Dexamethasone medicine.drug |
| Zdroj: | Cancer Management and Research. 11:789-801 |
| ISSN: | 1179-1322 |
| Popis: | Background Leptomeningeal carcinomatosis (LC) is a severe complication of metastatic tumor spread to the central nervous system. Prognosis is dismal with a median overall survival (OS) of ~10-15 weeks. Treatment options include radiotherapy (RT) to involved sites, systemic chemo- or targeted therapy, intrathecal chemotherapy and best supportive care with dexamethasone. Craniospinal irradiation (CSI) is a more aggressive radiotherapeutic approach, for which very limited data exists. Here, we report on our 10-year experience with palliative CSI of selected patients with LC. Patients and methods Twenty-five patients received CSI for the treatment of LC at our institution between 2008 and 2018. Patients were selected individually for CSI based on clinical performance, presenting symptoms and estimated benefit. Median patient age was 53 years (IQR: 45-59), and breast cancer was the most common primary. Additional brain metastases were found in 18 patients (72.0%). RT was delivered at a TomoTherapy machine, using helical intensity-modulated radiotherapy (IMRT). The most commonly prescribed dose was 36 Gy in 20 fractions, corresponding to a median biologically equivalent dose of 40.8 Gy (IQR: 39.0-2.5). Clinical performance and neurologic function were assessed before and in response to therapy, and deficits were retrospectively quantified on the 5-point neurologic function scale (NFS). A Cox proportional hazards model with univariate and multivariate analyses was fitted for survival. Results Twenty-one patients died and four were alive at the time of analysis. Median OS from LC diagnosis was 19.3 weeks (IQR: 9.3-34.0, 95% CI: 11.0-32.0). In univariate analysis, a Karnofsky performance scale index (KPI) ≥70% (P=0.001), age ≤55 years at LC diagnosis (P=0.022), cerebrospinal fluid (CSF) protein |
| Databáze: | OpenAIRE |
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