LEPTOMENINGEAL METASTASES DUE TO MELANOMA - COMBINED-MODALITY THERAPY

A Phase II study of combined modality therapy of leptomeningeal metast ases (LM) in melanoma was carried out. Central nervous system (CNS) me tastases occur commonly in patients with clinically advanced melanoma. 16 patients (median age 47; range 32-62 years) with LM due to metasta tic melanoma were treated. Neurologic presentation included: headache (9 patients); cranial neuropathies (6); cauda equina syndrome (4); gai t ataxia (3); hemiparesis (2); radiculopathy (2); myelopathy (1); and seizure (1). All patients underwent CNS staging followed by radiothera py (14 patients) and intraventricular chemotherapy (methotrexate 16 pa tients; ara-C 13 patients; thio-TEPA 7 patients). CNS imaging demonstr ated: interrupted CSF flow (9 patients); parenchymal brain metastases (7); spinal cord subarachnoid nodules (5); hydrocephalus (3); and epid ural spinal cord compression (2). CSF cytologic responses were seen in 4 patients to first-, 6 to second-, and 3 to third-line chemotherapy. Treatment-related toxicity included 13 patients with meningitis (12 c hemical; 1 bacterial) and 12 patients (18 episodes) with myelosupressi on (4 episodes secondary to intraventricular chemotherapy). Median sur vival was 4 months (range: 2-8). Twelve patients (75%) died of progres sive LM or combined LM and systemic disease progression. LM in patient s with metastatic melanoma may be palliated with combined modality the rapy, however, median survival is quite short suggesting a re-evaluati on of such an approach in similarly affected patients.