Malignant Glioma with Leptomeningeal Metastasis: A Case Series (P6.295)

Abstract

Background: Autopsy series suggest leptomeningeal metastasis (LM) occurs in 20[percnt] of GBM patients. The incidence of clinically evident LM is much lower and diagnosis is often challenging. We present 6 cases that illustrate this fact and review molecular-profiles, when available. Methods: Retrospective-chart review. Molecular profiles were generated by Foundation-Medicine. Results: Patient age at tumor diagnosis ranged from 26 to 72 years. Two were female, four male. Initial diagnosis was WHO grade-II astrocytoma in two, anaplastic astrocytoma (AA) in one, and glioblastoma (GBM) in three. Latency (time from initial tumor diagnosis to diagnosis of LM) ranged from 0 to 17 years. Parenchymal location of tumor at diagnosis included: two in frontal lobe and one each in temporal lobe, parietal lobe, cerebellum, and spinal cord. Both grade-II tumors had progressed to GBM at LM diagnosis. Neuro-imaging was supportive of the diagnosis in all cases. Synchronous new parenchymal lesions were present in four- cases. Cerebrospinal fluid (CSF) was abnormal in all cases analyzed (five of six) but CSF cytology was definitive in only 3. Treatment at the time of LM diagnosis ranged from supportive care to aggressive treatment with combinations of radiation and chemotherapy(systemic and intra-thecal). Survival ranged from one week to more than one year. Five patients were still alive at the time of this report. 4/5 patients electing therapy had both clinical and radiographic improvement. Quality of life at diagnosis of LM, as measured by Karnofsky Performance Status (KPS) ranged from 30 - 100[percnt]. Those with responses to treatment had either stable or improved KPS scores. Molecular profiles of original tumor specimens, all performed using the Foundation-Medicine platform, were available in 3 cases. Conclusions: Although profiles adhered to original tumor grade, no clear pattern was identified linking the profiles to risk of LM.

Disclosure: Dr. Kim has nothing to disclose. Dr. Amidei has nothing to disclose. Dr. Sica has nothing to disclose. Dr. Nicholas has nothing to disclose.