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A systematic review of craniospinal irradiation for leptomeningeal disease: past, present, and future

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Abstract

Purpose

Leptomeningeal disease (LMD) is a rare but deadly complication of cancer in which the disease spreads to the cerebrospinal fluid and seeds the meninges of the central nervous system (CNS). Craniospinal irradiation (CSI) involves treatment of the entire CNS subarachnoid space and is occasionally used as a last-resort palliative therapy for LMD.

Methods

This review examined literature describing the role of CSI for LMD from solid and hematologic malignancies in adults. A search for studies published until September 1, 2020 was conducted using PubMed database.

Results

A total of 262 unique articles were identified. Thirteen studies were included for analysis in which a total of 275 patients were treated with CSI for LMD. Median age at time of irradiation was 43 years, and most patients had KPS score of 70 and higher. The most common cancers resulting in LMD were acute lymphocytic leukemia, breast cancer, and acute myelogenous leukemia. Median CSI dose was 30 Gy and 18% of patients were treated with proton radiation. 52% of patients had stable-to-improved neurologic symptoms. Median overall survival for the entire cohort was 5.3 months. Patients treated with marrow-sparing proton radiation had median OS of 8 months. The most common treatment toxicities were hematologic and gastrointestinal events.

Conclusions

Despite advances in systemic and radiation therapies, LMD remains a devastating end-stage complication of some malignancies. Treatment-related toxicities can be a significant barrier to CSI delivery. In select patients with LMD, marrow-sparing proton CSI may provide safer palliation of symptoms and prolong survival.

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Authors and Affiliations

  1. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    L. Maillie & S. Lazarev

  2. Department of Radiation Oncology, Elmhurst Hospital, New York, NY, USA

    L. R. Salgado

  3. New York Proton Center, New York, NY, USA

    S. Lazarev

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Contributions

Study conceptualization: SL. Literature search: LM and SL. Analysis: LM and SL. Writing—original draft preparation: LM, LRS, and SL. Writing—review and editing: LM, LRS, and SL. Supervision: SL.

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Correspondence to S. Lazarev.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Maillie, L., Salgado, L.R. & Lazarev, S. A systematic review of craniospinal irradiation for leptomeningeal disease: past, present, and future. Clin Transl Oncol 23, 2109–2119 (2021). https://doi.org/10.1007/s12094-021-02615-8

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