Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 28, 2009; 15(40): 5086-5090
Published online Oct 28, 2009. doi: 10.3748/wjg.15.5086
Gastric leptomeningeal carcinomatosis: Multi-center retrospective analysis of 54 cases
Sung Yong Oh, Su-Jin Lee, Jeeyun Lee, Suee Lee, Sung-Hyun Kim, Hyuk-Chan Kwon, Gyeong-Won Lee, Jung Hun Kang, In Gyu Hwang, Joung-Soon Jang, Ho Yeong Lim, Young Suk Park, Won Ki Kang, Hyo-Jin Kim
Sung Yong Oh, Suee Lee, Sung-Hyun Kim, Hyuk-Chan Kwon, Hyo-Jin Kim, Department of Internal Medicine and Medical Research Center for Cancer Molecular Therapy, Dong-A University College of Medicine, Busan 602-715, South Korea
Su-Jin Lee, Jeeyun Lee, Ho Yeong Lim, Young Suk Park, Won Ki Kang, Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Seoul 135-710, South Korea
Gyeong-Won Lee, Jung Hun Kang, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju 660-702, South Korea
In Gyu Hwang, Joung-Soon Jang, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 140-757, South Korea
Author contributions: Oh SY and Lee SJ carried out data analysis and wrote the manuscript; Kim SH, Kwon HC, Lee S, Lee GW, Hwang IG and Lim HY participated in data collection and drafted the manuscript; Lee J, Kang JH, Jang JS and Park YS carried out data collection and interpretation; Kang WK and Kim HJ designed the study protocol and participated in reviewing the manuscript.
Supported by The Dong-A University Research Fund and the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MEST; R13-2002-044-05001-0)
Correspondence to: Hyo-Jin Kim, MD, PhD, Department of Internal Medicine, Dong-A University College of Medicine, 3-1 Dongdaeshin-dong, Seo-gu, Busan 602-715, South Korea.
Telephone: +82-51-2402951 Fax: +82-51-2465044
Received: July 13, 2009
Revised: September 18, 2009
Accepted: September 25, 2009
Published online: October 28, 2009

AIM: To identify the clinical features and outcomes of infrequently reported leptomeningeal carcinomatosis (LMC) of gastric cancer.

METHODS: We analyzed 54 cases of cytologically confirmed gastric LMC at four institutions from 1994 to 2007.

RESULTS: The male-to-female ratio was 32:22, and the patients ranged in age from 28 to 78 years (median, 48.5 years). The majority of patients had advanced disease at initial diagnosis of gastric cancer. The clinical or pathologic tumor, node and metastasis stage of the primary gastric cancer was IV in 38 patients (70%). The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 6.3 mo, ranging between 0 and 73.1 mo. Of the initial endoscopic findings for the 45 available patients, 23 (51%) of the patients were Bormann type III and 15 (33%) patients were Bormann type IV. Pathologically, 94% of cases proved to be poorly differentiated adenocarcinomas. Signet ring cell component was also observed in 40% of patients. Headache (85%) and nausea/vomiting (58%) were the most common presenting symptoms of LMC. A gadolinium-enhanced magnetic resonance imaging was conducted in 51 patients. Leptomeningeal enhancement was noted in 45 cases (82%). Intrathecal (IT) chemotherapy was administered to 36 patients-primarily methotrexate alone (61%), but also in combination with hydrocortisone/± Ara-C (39%). The median number of IT treatments was 7 (range, 1-18). Concomitant radiotherapy was administered to 18 patients, and concomitant chemotherapy to seven patients. Seventeen patients (46%) achieved cytological negative conversion. Median overall survival duration from the diagnosis of LMC was 6.7 wk (95% CI: 4.3-9.1 wk). In the univariate analysis of survival duration, hemoglobin, IT chemotherapy, and cytological negative conversion showed superior survival duration (P = 0.038, P = 0.010, and P = 0.002, respectively). However, in our multivariate analysis, only cytological negative conversion was predictive of relatively longer survival duration (3.6, 6.7 and 14.6 wk, P = 0.030, RR: 0.415, 95% CI: 0.188-0.918).

CONCLUSION: Although these patients had a fatal clinical course, cytologic negative conversion by IT chemotherapy may improve survival.

Keywords: Carcinomatosis, Gastric cancer, Intrathecal chemotherapy, Leptomeningeal