Prognostic significance of coexistent bulky metastatic central nervous system disease in patients with leptomeningeal metastases

Objective: To assess the clinical significance of bulky metastatic central nervous system disease in patients with leptomeningeal metastases. Patients and Methods: Forty patients (24 women and 16 men) ranging in age from 32 to 74 years (median, 56.5 years) with cytologically documented leptomeningeal metastases were demonstrated by cranial or spinal magnetic resonance imaging to have either no bulky central nervous system metastatic disease (group A; 20 patients) or bulky central nervous system metastatic disease (group B; 20 patients). Twenty-nine patients were treated with involved-field radiotherapy, and all patients were treated with sequential intraventricular chemotherapy. Results: Median 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 rank analysis). Cause of death was similar in both patient groups. Conclusions: In patients with leptomeningeal metastases, neuroradiographic demonstration of bulky metastatic central nervous system disease independently predicts survival and is useful in determining which patients are candidates for intraventricular chemotherapy.