PROGNOSTIC-SIGNIFICANCE OF COEXISTENT BULKY METASTATIC CENTRAL-NERVOUS-SYSTEM DISEASE IN PATIENTS WITH LEPTOMENINGEAL METASTASES

Objective: To assess the clinical significance of bulky metastatic cen tral nervous system disease in patients with leptomeningeal metastases . Patients and Methods: Forty patients (24 women and 16 men) ranging i n age from 32 to 74 years (median, 56.5 years) with cytologically docu mented leptomeningeal metastases were demonstrated by cranial or spina l magnetic resonance imaging to have either no bulky central nervous s ystem metastatic disease (group A; 20 patients) or bulky central nervo us system metastatic disease (group B; 20 patients). Twenty-nine patie nts were treated with involved-field radiotherapy, and all patients we re treated with sequential intraventricular chemotherapy. Results: Med ian survival was 7 months in group A (range, 5-12 months) as compared with 4 months in group B (range, 2-12 months) (P<.01; Mantel-Cox log r ank analysis). Cause of death was similar in both patient groups. Conc lusions: In patients with leptomeningeal metastases, neuroradiographic demonstration of bulky metastatic central nervous system disease inde pendently predicts survival and is useful in determining which patient s are candidates for intraventricular chemotherapy.