dc.contributor.author | Kingston, B | |
dc.contributor.author | Kayhanian, H | |
dc.contributor.author | Brooks, C | |
dc.contributor.author | Cox, N | |
dc.contributor.author | Chaabouni, N | |
dc.contributor.author | Redana, S | |
dc.contributor.author | Kalaitzaki, E | |
dc.contributor.author | Smith, I | |
dc.contributor.author | O'Brien, M | |
dc.contributor.author | Johnston, S | |
dc.contributor.author | Parton, M | |
dc.contributor.author | Noble, J | |
dc.contributor.author | Stanway, S | |
dc.contributor.author | Ring, A | |
dc.contributor.author | Turner, N | |
dc.contributor.author | Okines, A | |
dc.date.accessioned | 2017-11-23T10:18:23Z | |
dc.date.issued | 2017-12-01 | |
dc.identifier.citation | Breast (Edinburgh, Scotland), 2017, 36 pp. 54 - 59 | |
dc.identifier.issn | 0960-9776 | |
dc.identifier.uri | https://repository.icr.ac.uk/handle/internal/937 | |
dc.identifier.eissn | 1532-3080 | |
dc.identifier.doi | 10.1016/j.breast.2017.07.015 | |
dc.description.abstract | PURPOSE: Leptomeningeal disease (LMD) is an uncommon complication of advanced breast cancer. The prognosis is poor, and although radiotherapy (RT), systemic and intra-thecal (IT) chemotherapy are accepted treatment modalities, efficacy data are limited. This study was designed to evaluate potential predictors of survival in this patient group. METHODS: Breast cancer patients with LMD diagnosed by MRI in a 10-year period (2004-2014) were identified from electronic patient records. PFS and OS estimates were calculated using Kaplan-Meier method, with planned sub-group analysis by treatment modality. Cox regression was employed to identify significant prognostic variables. RESULTS: We identified 182 eligible patients; all female, median age at LMD diagnosis 52.5 years (range 23-80). Ninety patients (49.5%) were ER positive/HER2 negative; 48 (26.4%) were HER2 positive, and 27 (14.8%) were triple negative. HER2 status was unknown in 17 (9.3%). Initial management of LMD was most commonly whole or partial brain RT in 62 (34.1%), systemic therapy in 45 (24.7%) or supportive care alone in 37 (20.3%). Fourteen patients (7.7%) underwent IT chemotherapy, of whom two also received IT trastuzumab. From diagnosis of LMD, the median PFS was 3.9 months (95%CI 3.2-5.0) and median OS was 5.4 months (95%CI 4.2-6.6). Patients treated with systemic therapy had the longest OS (median 8.8 months, 95%CI 5.5-11.1), compared to RT; 6.1 months (95%CI 4.2-7.9 months), IT therapy; 2.9 months (95%CI 1.2-5.8) and supportive care; 1.7 months (95%CI 0.9-3.0). On multivariable analysis, triple negative histology, concomitant brain metastases, and LMD involving both the brain and spinal cord were associated with poor OS. CONCLUSIONS: Breast cancer patients with triple negative LMD, concomitant brain metastases or LMD affecting both the spine and brain have the poorest prognosis. Clinical trials to identify more effective treatments for these patients are urgently needed. | |
dc.format | Print-Electronic | |
dc.format.extent | 54 - 59 | |
dc.language | eng | |
dc.language.iso | eng | |
dc.publisher | CHURCHILL LIVINGSTONE | |
dc.rights.uri | https://www.rioxx.net/licenses/under-embargo-all-rights-reserved | |
dc.subject | Brain | |
dc.subject | Spinal Cord | |
dc.subject | Humans | |
dc.subject | Breast Neoplasms | |
dc.subject | Brain Neoplasms | |
dc.subject | Receptor, erbB-2 | |
dc.subject | Receptors, Estrogen | |
dc.subject | Receptors, Progesterone | |
dc.subject | Antineoplastic Combined Chemotherapy Protocols | |
dc.subject | Disease-Free Survival | |
dc.subject | Infusions, Intravenous | |
dc.subject | Survival Rate | |
dc.subject | Proportional Hazards Models | |
dc.subject | Retrospective Studies | |
dc.subject | Age Factors | |
dc.subject | Adult | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Middle Aged | |
dc.subject | Female | |
dc.subject | Meningeal Carcinomatosis | |
dc.subject | Young Adult | |
dc.subject | Kaplan-Meier Estimate | |
dc.subject | Infusions, Spinal | |
dc.subject | Trastuzumab | |
dc.subject | Antineoplastic Agents, Immunological | |
dc.title | Treatment and prognosis of leptomeningeal disease secondary to metastatic breast cancer: A single-centre experience. | |
dc.type | Journal Article | |
dcterms.dateAccepted | 2017-07-19 | |
rioxxterms.funder | The Institute of Cancer Research | |
rioxxterms.identifier.project | Unspecified | |
rioxxterms.versionofrecord | 10.1016/j.breast.2017.07.015 | |
rioxxterms.licenseref.uri | https://www.rioxx.net/licenses/under-embargo-all-rights-reserved | |
rioxxterms.licenseref.startdate | 2017-12 | |
rioxxterms.type | Journal Article/Review | |
dc.relation.isPartOf | Breast (Edinburgh, Scotland) | |
pubs.notes | Not known | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Breast Cancer Research | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Breast Cancer Research/Endocrine Therapy Resistance | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Breast Cancer Research/Molecular Oncology | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Treatment of thoracic tumours | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Treatment of thoracic tumours/Treatment of thoracic tumours (hon.) | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.organisational-group | /ICR/Students | |
pubs.organisational-group | /ICR/Students/PhD and MPhil | |
pubs.organisational-group | /ICR/Students/PhD and MPhil/17/18 Starting Cohort | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Breast Cancer Research | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Breast Cancer Research/Endocrine Therapy Resistance | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Breast Cancer Research/Molecular Oncology | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Treatment of thoracic tumours | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Treatment of thoracic tumours/Treatment of thoracic tumours (hon.) | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.organisational-group | /ICR/Students | |
pubs.organisational-group | /ICR/Students/PhD and MPhil | |
pubs.organisational-group | /ICR/Students/PhD and MPhil/17/18 Starting Cohort | |
pubs.publication-status | Published | |
pubs.volume | 36 | |
pubs.embargo.terms | Not known | |
icr.researchteam | Endocrine Therapy Resistance | |
icr.researchteam | Molecular Oncology | |
icr.researchteam | Medicine (RMH Smith Cunningham) | |
icr.researchteam | Treatment of thoracic tumours | |
dc.contributor.icrauthor | Kingston, Belinda | |
dc.contributor.icrauthor | Turner, Nicholas | |