A Retrospective Analysis Of77Meningeal Carcinomatosis Patients

Meningeal carcinomatosis is a special type of malignant tumorcomplications of advanced disease, and is defined as the malignantdisease which is caused by the metastasis of tumor cell to meninges(including the dura mater, arachnoid and soft membrane) and spinalmeninges, and the invasion of cancer cell into the brain parenchymaalong the vessel gap with no space occupied lesion in brain parenchyma.After treatment, patient’s overall survival time is prolonged, while theincidence rate of meningeal carcinomatosis increases year by year.Because of tumor cell involvement in brain parenchyma, terminalpatients’ health deteriorate and they suffer from varying clinicalsymptoms besides primary symptoms. These clinical manifestationsinclude intracranial hypertensions (headache, nausea, vomiting,papilledema, etc), epilepsy, mental confusion, damaged cranial nerve(ophthalmoplegia, diplopia, shock, etc) and damaged spinal nerve suchas numbness and lumbago. Head MRI strengthening examinationindicates linear meninges or enhancement nodules. Suspectedmeningeal carcinomatosis patients must take general examinationincluding cerebrospinal fluid cytology and immunological tests, evenmore lumbar puncture should be retested in order to get the diagnostic certainty. Meningeal carcinomatosis is often caused by many kinds oftumors including lung cancer, gastric cancer, breast cancer, prostatecancer, and melanoma. Sometimes no primary tumor can not be found.Its survival rate is poor due to terminal symptom after diagnosis andpowerless and limited treatment.Objective: With effective statistics and retrospective analysis on77cases of meningeal carcinomatosis, this study is to investigatemeningeal carcinomatosis about clinic symptoms, laboratory andimageological examination, and treatment outcome. These valuableresults will help identifying appropriate treatment plans in time toprolong the patients’ median survival time and improve prognosis.Methods: This study focuses on77cases of meningealcarcinomatosis who were hospitalized in Bethune first hospital of jilinuniversity from2003to2013. There are35cases of men (16cases ofprimary tumor)between ages2to72and42cases of women (14casesof primary tumors) between ages19to76. The studied clinicalcharacteristics include age, sex, etiology, first symptoms, commonclinical manifestations, signs, intracranial pressure, routine biochemistry,cytology, the number of lumbar puncture, immunological tests,primarytumors, the interval of between primary tumor and central nervoussystem symptoms, imaging examination (head CT and MRI scan andenhancement), serum tumor markers, treatment and survival time. Results: Meningeal carcinomatosis is not associated with sex.Median age at diagnosis is55with46.2%of acute onset and39.0%ofsubacute onset. The most primary symptom is intracranial hypertension(70.1%) such as headache, nausea and vomiting. The high lumbarpuncture intracranial pressure was observed in56%of cases, and21.1%of them showed over400mm H2O.95.3%cerebrospinal fluid routinebiochemical examination was abnormal, including high proteinconcentration(74%), increased white blood cells count (59.7%), and45%glucose lower.The positive rate of first lumbar puncturecerebrospinal fluid cytology was82.2%, and it can be improved byreview of cerebrospinal fluid cytology. In this study,only3cases of thecerebrospinal fluid tumor markers were checked, and the results wereabnormal. The rate of abnormal meninges in head MRI scan is13.2%,and meningeal enhanced in head MRI enhancement scanning is35.3%.The rate of abnormal serum tumor markers is84%. There was noobvious specificity in electroencephalogram. The primary tumorsincluded thirty five cases of lung cancer (58.3%), ten cases of gastriccancer(16.7%), six cases of breast cancer (10%), three cases ofmelanoma (5%), two cases of non-hodgkin’s lymphoma (3.3%), onecase of ovarian cancer (1.7%), one case of colon cancer (1.7%), onecase of nasopharyngeal carcinoma (1.7%), and one case of acutelymphocytic leukemia (1.7%). Seventeen cases (22.1%) had no primary tumor. Forty five cases (58.4%) with damaged central nervous systemhad no history of tumor, and other thirty two cases (41.6%) had primarytumor. There is no difference between mean survival time of patientswith intrathecal chemotherapy and whole brain radiotherapy andpatients with symptomatic and supportive treatment.Conclusions： Meningeal carcinomatosis can be found at anyages,the mean age is55and the form of onset is mainly acute orsubacute.70.1%of clinical manifestations of meningeal carcinomatosisis headache, nausea and vomiting which is called intracranialhypertension. The strengthen of meningeal showed on the MRIenhancement scan is of great important value for the supportivediagnosis. The intracranial pressure is increased,the protein and whiteblood cell in cerebrospinal fluid is also increased moderately, mainlymononuclear cell.The gold standard for clinical diagnosis of meningealcarcinomatosis relies principally on tumor cells found in cerebrospinalfluid. The most common primary tumor is lung cancer, followed bygastric cancer, breast cancer and so on.