CARCINOMATOUS MENINGITIS IN PATIENTS WITH BREAST-CANCER - AN AGGRESSIVE DISEASE VARIANT

Background. Carcinomatous meningitis is a rare and often devastating c omplication in patients with breast cancer, and the treatment is contr oversial. Methods. A retrospective analysis of 35 patients with carcin omatous meningitis from breast cancer was performed to define the biol ogy of the disease and to guide treatment. Results. An aggressive vari ant of breast cancer was revealed: meningeal metastasis complicates le ss than 3.5% of cases of metastatic breast carcinoma. Sixty-seven perc ent of these patients had tumors that were lobular or combined lobular /ductal histology; the median intervals from primary treatment to dise ase recurrence and from recurrence to death were 10.9 and 15 months, r espectively. The median survival after diagnosis of carcinomatous meni ngitis was 77 days. The most significant prognostic factor was the Kar nofsky performance status (KP) at presentation of meningeal disease. P atients with a KP greater or equal to 70 survived a median of 313 days , whereas those with a KP of 60 or less survived for a median of 36 da ys (P = 0.0002), In addition, there was a trend suggesting that the re sponse 2 weeks after treatment was initiated, correlated with survival . Conclusions. Carcinomatous meningitis from breast carcinoma is an ag gressive metastatic complication with a poor prognosis. The authors su ggest that patients with a poor KP (< 70) should be treated symptomati cally and those with a good KP (greater than or equal to 70) should re ceive more aggressive treatment The patients' survival in this study c ompared well with other reports, and yet, only one patient was treated with intraventricular chemotherapy. Therefore, these data question th e superiority of intraventricular treatment versus other modalities.