Neoplastic Meningitis Survival as a Function of Cerebrospinal Fluid Cytology

BACKGROUND: This retrospective comparison evaluated survival in 2 well-matched cohorts of patients with neoplastic meningitis (NM) presenting with or without positive cerebrospinal fluid (CSF) cytology. METHODS: Two patient cohorts were studied: 42 individuals with (Group A) and 42 without (Group B) positive CSF cytology. Groups were matched with respect to age; primary tumor; Karnofsky performance status; site of NM disease (cranial nerves or spinal cord); treatment (radiotherapy and chemotherapy; systemic and intraventricular); and absence of CSF compartmentalization, NM-related encephalopathy, and neuroradiographic bulky central nervous system disease. Primary tumor histology included breast (28 patients), non-Hodgkin lymphoma (14 patients), nonsmall cell lung cancer (14 patients), melanoma (12 patients), and others (16 patients). NM at presentation revealed cranial neuropathy (40 patients) or spinal cord dysfunction (58 patients). Radiotherapy was administered to 69 patients (whole brain only in 14 patients [7 each in Groups A and B], restricted spine only in 51 patients [25 in Group A and 26 in Group B], and both whole brain and restricted spine in 4 patients [2 each in Groups A and 13]). All patients received intraventricular chemotherapy and 60 (30 each in Groups A and B) received concurrent tumor-specific systemic chemotherapy. RESULTS: The median, 3-month, 6-month, and 12-month survival rates for patients with NM were not significantly different between those patients with positive CSF cytology (18 weeks, 83%, 33%, and 9.5%, respectively) and those without positive CSF cytology (20 weeks, 90.5%, 40.5%, and 9.5%, respectively). All patients demonstrated progressive disease and died of either NM or systemic cancer. CONCLUSIONS: In patients with NM who were matched for known prognostic variables, the presence or absence of CSF cytology did not appear to influence survival. Cancer 2009;115:1941-6. (C) 2009 American Cancer Society.