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A phase Ⅱ trial of comprehensive treatment based on radiotherapy in leptomeningeal metastasis
Yang Siran1, Liu Qingfeng1, Xiao Jianping1, Zhang Hongmei1, Bi Nan1, Zhang Ye1, Ma Yuchao1, Wang Kai1, Chen Xuesong1, Zhao Ruizhi1, Wu Xi2, Li Junling3, Yi Junlin1, Wang Shulian1, Li Yexiong1
1Department of Radiation Oncology,2Department of General,3Department of Internal Medicine, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
AbstractObjective To evaluate the efficacy and safety of comprehensive treatment based on radiotherapy for patients with leptomeningeal metastases (LM) in this prospective study. Methods A total of 93 patients diagnosed with LM admitted to our hospital undergoing whole brain radiotherapy (WBRT) or craniospinal irradiation (CSI) with or without simultaneous boost from 2014 to 2017 were enrolled. The dynamic changes of clinical signs and symptoms, enhanced magnetic resonance imaging (MRI), cerebrospinal fluid cytology and liquid biopsy detection were recorded. The primary endpoint was overall survival (OS),the secondary endpoints were local control (LC), intracranial progress-free survival (IPFS), brain metastasis specific survival (BMSS) and toxicity. Results The major primary disease was non-small cell lung cancer. The whole cohort received WBRT with boost (40 Gy in 20 fractions (f) for WBRT and 60Gy in 20 f for boost), focal radiation to LM, WBRT and CSI (40 Gy in 20 f or 50Gy in 25 f for WBRT and 36 Gy in 20 f for CSI). For 20 patients, tumor cells were identified and intrathecal chemotherapy was performed. Sixty-three patients received target therapy. The median follow-up time was 33.8 months. The 1-year OS, LC and IPFS was 62.4%, 77.2% and 52.6%, respectively. The median survival time was 15.9 months, and the median BMSS was 42.2 months.Treatment-related grade 3–4 adverse events were rare and only 8 cases was observed to have grade 3 hematological toxicity. Conclusion Reasonable comprehensive treatment including precise radiotherapy, intrathecal chemotherapy and targeted therapy can be well tolerated and prolong the survival time of LM patients.
Fund:National Major Special Project (2016YFC0904600);Beijing Hope Marathon Special Fund (LC2014A05);Neurotumor Research Fund Of Neurotumor Committee of China AntiCancer Association (CSNO-2015-MSD01)
Yang Siran,Liu Qingfeng,Xiao Jianping et al. A phase Ⅱ trial of comprehensive treatment based on radiotherapy in leptomeningeal metastasis[J]. Chinese Journal of Radiation Oncology, 2020, 29(9): 744-750.
Yang Siran,Liu Qingfeng,Xiao Jianping et al. A phase Ⅱ trial of comprehensive treatment based on radiotherapy in leptomeningeal metastasis[J]. Chinese Journal of Radiation Oncology, 2020, 29(9): 744-750.
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