Leptomeningeal metastasis in a breast cancer treated with two lines of intrathecal chemotherapy: A case report.

Vanda Mikudova


Background: Leptomeningeal metastasis (LM) in breast cancer is associated with poor prognosis. Although no randomised trial has demonstrated that intrathecal chemotherapy prolongs survival this treatment is considered standard of care in this setting. Prognosis of patients with LM is poor, with median overall survival less than 6 months.

Methods: Herein, we report a case of young woman with breast cancer presented with leptomeningeal metastasis at the time of relapse and subsequently treated with two lines of intrathecal chemotherapy with prolonged survival.

Results: A 28-year old woman without significant past medical history was diagnosed with triple-negative invasive ductal carcinoma. Eight months after adjuvant treatment she developed multiple brain metastases and subsequently one months after finishing whole brain irradiation, LM developed. Initially, she was treated with combination of methotrexate, cytarabine and dexamethasone intrathecally but after 3 months the patient was presented with worsening of clinical status and increased of cancer cells in CSF. Subsequently, she received combination of thiotepa and methotrexate intrathecally with prolonged response lasting for 10 months. Patient died 32 months after initial diagnosis and 18 months from LM infiltration due to disease progression in the liver and lungs as well as in LM.

Conclusions: Prognosis of patients with LM remains poor because of the limited effectiveness of the currently available agents used in intrathecal therapies, however, intrathecal chemotherapy could substantially prolong survival in selected patients


Key words: Leptomeningeal metastasis, breast cancer, intrathecal treatment, thiotepa.

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Leptomeningeal metastasis, breast cancer, intrathecal treatment, thiotepa

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