KEY TAKEAWAYS
- The study aimed to investigate the prognostic factors of LM, incorporating both radiological and cytological classifications.
- Researchers noticed the validated efficacy of prognostication based on the EANO-ESMO guidelines for LM, highlighting improved survival in NSCLC patients with systemic therapy post-diagnosis.
The increasing prevalence of leptomeningeal metastasis (LM) among cancer patients underscores the need for accurate prognostication to guide treatment decisions. While the European Association of Neuro-Oncology-European Society for Medical Oncology (EANO-ESMO) guidelines propose a classification system integrating cerebrospinal fluid cytology and MRI findings, its validation remains limited.
Kanji Nakagawa and the team aimed to investigate the prognostic factors in LM, including radiological and cytological characteristics.
They performed an inclusive analysis, retrospectively examining data from 240 adult patients suspected of LM who underwent lumbar puncture between April 2014 and September 2021.
Researchers found that non-small-cell lung cancer (NSCLC) and breast cancer (BC) were the most common primary cancer types among the 240 patients analyzed, with NSCLC comprising 60% and BC (27 (11%)). Positive cytology results and leptomeningeal lesions on contrast-enhanced MRI were associated with reduced survival across all patients.
Additionally, nodular lesions identified on contrast-enhanced magnetic resonance were identified as a negative prognostic factor in cytology-negative patients, while contrast-enhanced patterns showed no prognostic significance in cytology-positive patients.
Systemic therapy with cytotoxic agents and molecular-targeted therapy post-LM diagnosis correlated with extended survival, irrespective of cytology results. Furthermore, treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors and systemic chemotherapy following LM diagnosis improved survival in both EGFR-mutated and wild-type NSCLC patients with positive cytology results.
The study concluded that the efficacy of prognostication aligned with the EANO-ESMO guidelines for LM was validated. Moreover, it highlighted the survival benefits of systemic therapy following LM diagnosis in patients with NSCLC.
The study received no funds.
Source: https://link.springer.com/article/10.1007/s11060-024-04616-3
Nakagawa, K., Takano, K., Nishino, K., et al. “Prognostic impact of clinical and radiological factors on leptomeningeal metastasis from solid cancers.” J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04616-3
