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Robert Grant, MD, MRCP, MB, ChB; Bernard Naylor, MS, MB, ChB; Harry S. Greenberg, MD; Larry Junck, MD

Arch Neurol. 1994;51(5):457-461.

Abstract
Objective
To critically evaluate the clinical outcome of patients with cytologically proved meningeal carcinomatosis and to identify factors associated with an improved outcome.

Design
A consecutive series of patients was identified from a cytopathology data base. The study period was from 1985 to 1990. Case records and results of radiologic investigations were reviewed; all patients were followed up until their deaths.

Setting
University hospital with a cancer center.

Patients
Thirty-six consecutive patients with cytologically proved meningeal carcinomatosis. Patients with lymphoma or leukemia were excluded.

Interventions
External beam radiation therapy, intrathecal chemotherapy via a ventricular catheter, and intravenous chemotherapy.

Main Outcome Measures
Clinical assessment and survival.

Results
Symptoms improved in 15% of 33 treated patients. Response to treatment had no clear relationship with the age, site of involvement, or tumor type. Median survival for treated patients was only 9 weeks. Patients who received more than five intrareservoir chemotherapy treatments had a median survival of 23 weeks. Median survival for patients with breast carcinoma who received intravenous chemotherapy was 20 weeks, significantly better than that of patients not receiving intravenous chemotherapy.

Conclusions
Survival is poor despite aggressive treatment. Intravenous chemotherapy may improve survival in patients with chemoresponsive primary tumors and deserves further study.

Author Affiliations
From the Departments of Neurology (Drs Grant, Greenberg, and Junck) and Pathology (Mr Naylor), University of Michigan Hospitals, Ann Arbor. Dr Grant is now with the Department of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland.

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