402 - Risk of meningeal involvement in metastatic breast cancer patients

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Breast Cancer, Metastatic
Presenter Gloria Mittica
Authors G. Mittica1, M. Donadio2, R. Senetta3, R. Rudà4, L. Ciuffreda1, P. Cassoni3, A. Sapino3
  • 1Oncohaematology, San Giovanni battista Hospital, 10126 - Turin/IT
  • 2Oncologia, San Giovanni battista Hospital, 10126 - Turin/IT
  • 3Biomedical Sciences And Human Oncology, University of Turin, 10126 - Turin/IT
  • 4Neuro-oncology, University and San Giovanni Battista Hospital, 10126 - Turin/IT

Abstract

Background

Meningeal Carcinomatosis (MC) occurs in 4-15% of patients with solid tumors, usually as a late event in the natural history of disease. Improvement in cancer treatments and patient survival and advances in neuro-imaging techniques have recently led to an increased incidence of MC, mostly in metastatic breast cancer. About 2-5% of breast cancer patients develop MC: median overall survival is 4-6 weeks without treatment and about 2-6 months when specific therapies are used. Objective: The aim of our study is to determine clinical, histological and immunological patterns of primary breast cancer which increase risk of MC.

Patients and methods

We performed a retrospective analysis of a cohort of 1037 consecutive patients treated for breast cancer from April 1994 to May 2010 at San Giovanni Battista Hospital in Turin. Diagnosis of MC was carried out in presence of neoplastic cells at cerebrospinal fluid citology. In case of negative or inconclusive citology, despite the presence of a characteristic clinical picture of MC, diagnosis was made using neuro-radiological findings, obtained by magnetic resonance imaging.

Results

We found 29 of 1037 breast cancer patients (2,8%) who developed MC. Among continuous variables associated with increased risk of MC (p < 0,001) there are young age (median age 46 years for MC positive versus 60.7 years for MC negative), tumor diameter (greater than 3.5 cm) and number of metastatic lymph-nodes (greater than 8). Discrete variables significantly associated with MC were: high tumor grade (p = 0,001), presence of vascular invasion (p = 0,038), greater tumor staging (pT3, pT4 p < 0,001) and axillar staging (pN3 p = 0,002), hormonal receptor negativity (p < 0,001) and Her-2 overexpression (p = 0,001). Multivariate analysis showed that only the presence of other distant metastases (p < 0,005) was significantly associated with high risk of develop MC with an odds ratio of 9.8.

Conclusions

We identified breast cancer patients at high risk to develop MC. These patients may benefit from an early diagnosis of MC to obtain better results with current treatments and to improve quality of life.

Disclosure

All authors have declared no conflicts of interest.