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Diagnosis and treatment patterns for patients with leptomeningeal metastasis from solid tumors across Europe

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Abstract

Leptomeningeal metastases are a late manifestation of systemic cancer which affects up to 10% of patients with solid tumors. Prognosis is poor, and overall survival at 1 year is only approximately 10%. Management depends mainly on general and neurological condition, primary tumor, and patterns of metastasis, notably absence or presence of concurrent systemic or solid brain metastases. Here we set out to characterize current practice patterns of diagnosis and treatment of patients with leptomeningeal metastasis in Europe. We prepared a web-based survey including 25 simple or multiple choices questions on best practice supplemented by eight case vignettes with various diagnosis and management options. The survey was sent to the membership of the European Association of Neuro-Oncology and the European Organisation for Research and Treatment of Cancer Brain Tumor Group. Between April 7, 2016 and August 8, 2016, 224 colleagues from 26 countries initiated the survey, 115 colleagues completed the whole survey. There were major differences both in the general diagnostic and therapeutic approach, e.g., regarding the use of cerebrospinal fluid (CSF) flow studies, intra-CSF chemotherapy, various types of radiotherapy, and even more so when selecting decisions on diagnostic and therapeutic measures for single case vignettes. Diagnosis and treatment decisions for patients with leptomeningeal metastasis from solid tumors vary widely across Europe. Standardization of diagnosis and evaluation tools as well as controlled studies to improve the level of evidence for all therapeutic approaches to LM are required.

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Acknowledgements

The authors thank Maryline Vo and the North East Neuro-Oncology Group (NENO) (Nancy, France) for creating and supporting the web-based survey tool. The authors thank all participants for time and effort to work on the questionnaire.

Author information

Authors and Affiliations

  1. Lille University, Inserm U1191 PRISM, Villeneuve d’Ascq, France

    Emilie Le Rhun

  2. Neuro-Oncology, Department of Neurosurgery, Rue Emile Laine, University Hospital – CHRU, 59037, Lille Cedex, France

    Emilie Le Rhun

  3. Breast Unit, Department of Medical Oncology, Oscar Lambret Center, Lille, France

    Emilie Le Rhun

  4. Department of Neurology, University Hospital and University of Zurich, Clinical Neuroscience Center, Zurich, Switzerland

    Emilie Le Rhun & Michael Weller

  5. Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy

    Roberta Rudà & Riccardo Soffietti

  6. Lille University, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, 59000, Lille, France

    Patrick Devos

  7. Department of Neuro-Oncology Marazin, Pitie-Salpetriere Hospital and University Pierre et Marie Curie, Paris VI (on behalf of the Association de Neuro-Oncologie d’Expression Française (ANOCEF)), Paris, France

    Khê Hoang-Xuan

  8. Department of Neuro-Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek (on behalf of the Dutch Neuro-Oncology Group), Amsterdam, The Netherlands

    Dieta Brandsma

  9. Medical Oncology Department, Hospital Clínico San Carlos (on behalf of Spanish Group of Investigation in Neurooncology (GEINO)), Madrid, Spain

    Pedro Pérez Segura

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  1. Emilie Le Rhun
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Correspondence to Emilie Le Rhun.

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Conflict of interest

Emilie Le Rhun: research funding (Mundipharma); Dieta Brandsma: research funding (BBB pharmaceuticals); Roberta Rudà, Patrick Devos, Riccardo Soffietti, Michael Weller: no conflict of interest.

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Le Rhun, E., Rudà, R., Devos, P. et al. Diagnosis and treatment patterns for patients with leptomeningeal metastasis from solid tumors across Europe. J Neurooncol 133, 419–427 (2017). https://doi.org/10.1007/s11060-017-2452-6

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  • DOI: https://doi.org/10.1007/s11060-017-2452-6

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