Leptomeningeal metastasis from non-small cell lung cancer: Survival and the impact of whole brain radiotherapy

Patrick G. Morris, Anne S. Reiner, Olga Rosenvald Szenberg, Jennifer L. Clarke, Katherine S. Panageas, Hector R. Perez, Mark G. Kris, Timothy A. Chan, Lisa M. DeAngelis, Antonio M. Omuro

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Introduction: Leptomeningeal metastasis (LM), or leptomeningeal carcinomatosis, is a devastating complication of non-small cell lung cancer (NSCLC), and the optimal therapeutic approach remains challenging. A retrospective review was carried out to assess the impact of whole brain radiotherapy (WBRT), intrathecal therapy (IT), and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on outcomes. Methods: Patients with newly diagnosed LM from NSCLC from January 2002 to December 2009 were identified through institutional databases and medical records reviewed. Survival was assessed by Kaplan-Meier and landmark analyses by administered treatment to minimize selection bias. Results: We identified 125 patients (45 men, 80 women) with LM from NSCLC, median age 59 years (range, 28-87 years). Almost all (123 [98%]) patients have died and median overall survival was 3.0 months (95% confidence interval, 2.0-4.0). No differences in survival were seen between patients who were treated with WBRT (n = 46) and those who were not (n = 59, p = 0.84) in a landmark analysis. In the seven patients selected to receive IT chemotherapy, median survival was 18 months (range, 5-33 months) and appeared superior to those not selected for this treatment (p = 0.001) in a landmark analysis. The median survival of the nine patients with known EGFR mutations (all of whom received TKIs at some point) was 14 months (range, 1-28 months). Conclusions: This retrospective study, the largest published series, demonstrates the poor survival of LM from NSCLC. In this study, survival was not improved by WBRT. The survival of patients selected for IT chemotherapy and those with EGFR mutations treated with TKIs highlights the importance of developing novel agents.

Original languageEnglish (US)
Pages (from-to)382-385
Number of pages4
JournalJournal of Thoracic Oncology
Volume7
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Radiotherapy
Neoplasm Metastasis
Survival
Brain
Epidermal Growth Factor Receptor
Protein-Tyrosine Kinases
Therapeutics
Meningeal Carcinomatosis
Drug Therapy
Mutation
Selection Bias
Kaplan-Meier Estimate
Medical Records
Retrospective Studies
Databases
Confidence Intervals

Keywords

  • Intrathecal chemotherapy
  • Leptomeningeal carcinomatosis
  • Leptomeningeal metastasis
  • Non-small cell
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Leptomeningeal metastasis from non-small cell lung cancer : Survival and the impact of whole brain radiotherapy. / Morris, Patrick G.; Reiner, Anne S.; Szenberg, Olga Rosenvald; Clarke, Jennifer L.; Panageas, Katherine S.; Perez, Hector R.; Kris, Mark G.; Chan, Timothy A.; DeAngelis, Lisa M.; Omuro, Antonio M.

In: Journal of Thoracic Oncology, Vol. 7, No. 2, 02.2012, p. 382-385.

Research output: Contribution to journalArticle

Morris, PG, Reiner, AS, Szenberg, OR, Clarke, JL, Panageas, KS, Perez, HR, Kris, MG, Chan, TA, DeAngelis, LM & Omuro, AM 2012, 'Leptomeningeal metastasis from non-small cell lung cancer: Survival and the impact of whole brain radiotherapy', Journal of Thoracic Oncology, vol. 7, no. 2, pp. 382-385. https://doi.org/10.1097/JTO.0b013e3182398e4f
Morris, Patrick G. ; Reiner, Anne S. ; Szenberg, Olga Rosenvald ; Clarke, Jennifer L. ; Panageas, Katherine S. ; Perez, Hector R. ; Kris, Mark G. ; Chan, Timothy A. ; DeAngelis, Lisa M. ; Omuro, Antonio M. / Leptomeningeal metastasis from non-small cell lung cancer : Survival and the impact of whole brain radiotherapy. In: Journal of Thoracic Oncology. 2012 ; Vol. 7, No. 2. pp. 382-385.
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abstract = "Introduction: Leptomeningeal metastasis (LM), or leptomeningeal carcinomatosis, is a devastating complication of non-small cell lung cancer (NSCLC), and the optimal therapeutic approach remains challenging. A retrospective review was carried out to assess the impact of whole brain radiotherapy (WBRT), intrathecal therapy (IT), and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on outcomes. Methods: Patients with newly diagnosed LM from NSCLC from January 2002 to December 2009 were identified through institutional databases and medical records reviewed. Survival was assessed by Kaplan-Meier and landmark analyses by administered treatment to minimize selection bias. Results: We identified 125 patients (45 men, 80 women) with LM from NSCLC, median age 59 years (range, 28-87 years). Almost all (123 [98{\%}]) patients have died and median overall survival was 3.0 months (95{\%} confidence interval, 2.0-4.0). No differences in survival were seen between patients who were treated with WBRT (n = 46) and those who were not (n = 59, p = 0.84) in a landmark analysis. In the seven patients selected to receive IT chemotherapy, median survival was 18 months (range, 5-33 months) and appeared superior to those not selected for this treatment (p = 0.001) in a landmark analysis. The median survival of the nine patients with known EGFR mutations (all of whom received TKIs at some point) was 14 months (range, 1-28 months). Conclusions: This retrospective study, the largest published series, demonstrates the poor survival of LM from NSCLC. In this study, survival was not improved by WBRT. The survival of patients selected for IT chemotherapy and those with EGFR mutations treated with TKIs highlights the importance of developing novel agents.",
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T2 - Survival and the impact of whole brain radiotherapy

AU - Morris, Patrick G.

AU - Reiner, Anne S.

AU - Szenberg, Olga Rosenvald

AU - Clarke, Jennifer L.

AU - Panageas, Katherine S.

AU - Perez, Hector R.

AU - Kris, Mark G.

AU - Chan, Timothy A.

AU - DeAngelis, Lisa M.

AU - Omuro, Antonio M.

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