Abstract 320P
Background
Breast cancer is common cause of meningeal carcinomatosis (MC). Treatment is chosen by expert opinion due to lack of prospective randomized clinical trials related to therapy. We present here a cohort of patients with MC treated at our institution from 2013 to 2020.
Methods
We evaluated clinical characteristics of consecutive metastatic breast cancer patients including diagnostic methods, treatment and survival.
Results
A total of 109 female patients with mean age of 55.5 years (26-79) were included. Performance status (PS), was analyzed according to Eastern Cooperative Oncology Group (ECOG), in which 38.5% had ECOG 0-1 and 61.5% ECOG 2-4. Histopathologic characteristics resulted in 80.73% cases of ductal carcinoma; 54.13% histologic grade 2 and 69.72% estrogen receptor+/HER2-. At the time of MC diagnosis 92.66% had evidence of distance disease, 78.90% to bone, 58.72% to visceral and 31.19% brain metastasis. Neoplastic cells in cerebrospinal fluid were present in 60.55% cases. Radiological exams showed leptomeningeal contrast enhancement in 64.22%. Treatment consist on radiotherapy (RT) 36.7%, intrathecal chemotherapy (intra-CT) 44.95%, and 24.77% received systemic treatment (ST), such as chemotherapy or hormone therapy. 13.76% received best supportive care (BSC). Overall survival (OS) was 2.1 months (min. 0.06 and max 33.2 months) and neurological progression-free survival was 1.73 months (min 0.03 and max 33.03 months). OS related to instituted therapy using COX regression analysis (yes versus no treatment) was 9.3 vs 1.9 months in ST group; 1.8 vs 2.4 months in intra-CT group; 3.0 vs 1.5 months in RT group. Comparative analysis of survival was performed by Kaplan-Meier curves. Median survival in the ST group was 2.53 months, combination of ST plus intra-CT was 1.44 months and BSC was 0.96 months. Clinical response, defined as neurological improvement and no new symptom, was assessed by Fischer's exact test. The group that matched clinical response was RT group (p<0.05). Factors of poor prognosis analyzed by univariate Cox regression were ECOG 2-4, liver metastasis and decreased level of consciousness (p<0.10).
Conclusions
Intrathecal chemotherapy did not improve symptoms and overall survival. Main prognostic factors observed were PS, liver metastasis and decrease level of consciousness.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.