Table 1 Compendium of cases of leptomeningeal carcinomatosis (LCM) from primary head and neck squamous cell carcinoma
Author, year of publication | Age (years)/sex | Primary cancer site, histology and initial management | Time to LCM | Presenting symptoms of LCM | Imaging findings | CSF analysis | Treatment of LCM | Survival outcome |
|---|---|---|---|---|---|---|---|---|
Banerjee et al. [16] (1984) | 70/male | Carcinoma lip (SCC); wide local excision of tumour | 8 months | Right mental neuropathy, right 5th, 7th, 8th CNP, complete ophthalmoplegia | CT head—normal. There was biopsy-proven metastases to mandible | Protein—elevated, glucose—decreased, cytology—positive for tumour cells | Weekly intravenous MTX and bleomycin | Died after 12 months from the diagnosis of LCM and 26 months from the diagnosis of cancer |
Redman et al. [17] (1986) | 30/male | Carcinoma of ethmoid sinus (SCC); Chemotherapy: CDDP, VCR, Bleomycin f/b RT | 7 months | Nausea, vomiting, decreased vision in left eye, decreased sensation over the left side of face, status epilepticus | CT scan—normal | Protein—elevated, cytology- positive for tumour cells | Whole brain RT➔ weekly IT MTX | Died after 10 months from the diagnosis of LCM |
Redman et al. [17] (1986) | 29/male | Carcinoma nasopharynx (PDSCC); surgery ➔ RT; recurrence in oropharynx after 6 months: surgery ➔ RT | 4 months | Bifrontal headache with nausea, vomiting, dizziness; optic atrophy on right side and papillitis on left side; anisocoria, 6th cranial nerve palsy (6 months after diagnosis of LCM); seizure (10 months after diagnosis of LCM) | Initial CT scan normal; CT scan at 2 months after diagnosis of LCM—bifrontal extradural tumour extension with involvement of both optic nerves; CT scan at 7 months after diagnosis of LCM—bifrontal meningeal enhancement with no intracranial lesion | At 7 months after diagnosis of LCM: protein—elevated, glucose—normal, cytology—no malignant cell; At 10 months after diagnosis of LCM: protein—elevated, glucose—decreased, cytology—positive for tumour cells | Systemic chemotherapy—CDDP and 5FU | Died after 11 months from the diagnosis of LCM |
Redman et al. [17] (1986) | 34/male | Carcinoma base of tongue with cervical lymph node metastasis (SCC); surgery ➔ RT | 16 months | Occipital headache with blurred vision in left eye; blindness in the left eye, decreased vision in the right eye (3 months after diagnosis of LCM); motor seizure (6 months after diagnosis of LCM) | CT scan—tumour recurrence with extension to left orbital apex, cavernous sinus and sphenoid sinus | Protein—elevated, cytology—negative for tumour cells; At 8 and 13 months after diagnosis of LCM: same as before; CSF from Ommaya reservoir positive for malignant cells | Systemic chemotherapy—CDDP and 5FU; weekly intraventricular chemotherapy with MTX via Ommaya reservoir | Died after 22 months from the diagnosis of LCM |
Redman et al. [17] (1986) | 44/male | Carcinoma of right ethmoid sinus (PDSCC) | At presentation | Anosmia, cephalgia, right-sided proptosis, anisocoria, right lateral gaze palsy | CT scan—obliteration of ethmoid sinus with an extension of tumour through the floor of the anterior fossa, compression of the right lateral ventricle | Protein—elevated, cytology—positive for tumour cells | Systemic chemotherapy-CDDP and 5FU; steroids and emergency cranial decompression; cranial RT; weekly intraventricular chemotherapy with MTX | Died after 21 months from the diagnosis of LCM |
Biswal et al. [18] (1998) | 50/male | Carcinoma right tonsil cT3N2aM0 (WDSCC); Palliative RT (30 Gy/10 fr/2 weeks) ➔ radical conversion to equivalent dose of 70 Gy | 7 months | Headache, deafness, diplopia, nasal regurgitation, hoarseness, bilateral 7th and 8th cranial nerve palsies | MRI—normal, Gd DTPA scan—prepontine deposit; biopsy proven metastatic skin nodules; CXR—multiple lung metastases | CSF cytology-positive for malignant cells | Palliative RT to whole brain 20 Gy/5 fr/1 week | Died after 1 month from the diagnosis of LCM |
Thompson et al. [19] (2003) | 51/male | Carcinoma left glottis T1N0M0 (SCC); Definitive RT (60 Gy/30 fr); Carcinoma left supraglottic larynx (SPC after 12 years) T1N3M0 (SCC): laryngectomy and MRND ➔ adjuvant RT to right neck (50 Gy/25 fr) and RT to left neck (60 Gy/30 fr) | 5 months | Low backache, decreased sensation in both lower limbs, constipation, inability to bear weight | MRI lumbar spine—leptomeningeal enhancement; CXR—normal | CSF cytology-atypical cells | IT MTX RT(20 Gy/5 fr) to T12- S3 level | Died after 3 weeks from the completion of palliative RT |
Lee et al. [ 20] (2005) | 43/female | Carcinoma nasopharynx (SCC); RT and concurrent chemotherapy with cisplatin and 5FU | 4 years | Right-sided facial weakness, numbness, loss of taste and smell, pain in right maxillary area, twitching in right facial musculature, right retroorbital pain, diplopia | MRI at 2 years after diagnosis of LCM: recurrent nasopharyngeal mass with involvement of ethmoid sinus and extension to frontotemporal leptomeninges | CSF cytology—negative for malignant cells | Systemic chemotherapy—MTX, 5FU with leucovorin | Died after 3 years from the initial diagnosis of LCM |
Sullivan et al. [21] 2006 | 51/male | Carcinoma lower lip(SCC); Local excision of tumour; Local recurrence after 3 years (SCC); wide local excision of tumour with mandibular resection➔ post-op RT (54 Gy/27 fr) | 4 years | Paraesthesia over right cheek and forehead Right radicular pain, right foot drop, left leg paraesthesia, decreased sensation in L4-L5 dermatomes on right and S1, 2 dermatomes on left (during stereotactic RT to the right cavernous sinus lesion) | Ill-defined enhancing mass below right foramen ovale with abnormal enhancement and thickening in cavernous sinus and PNI of the right trigeminal nerve MRI spine during stereotactic RT to right cavernous sinus lesion—multiple meningeal nodules in cervical and lumbar spine | Protein—elevated, cytology—negative for malignant cells | Stereotactic RT to the right cavernous sinus lesion (66 Gy/33 fr) Dexamethasone 4 mg QID and whole spinal RT (35 Gy/15 fr) | Died after 3 months from the completion of spinal RT |
Pougnet et al. [22] (2014) | 33/male | Carcinoma lip (WDSCC) post resection with perineural invasion of the trigeminal nerve within temporal fossa; Definitive CTRT (70 Gy/35 fr) with concurrent cisplatin and 5FU | 12 months | Paraparesis and back pain Progressive back pain, sphincter disorder and lower limb weakness (24 months after diagnosis of LCM) | Medullary myelitis without meningeal enhancement; MRI at 27 months after diagnosis of LCM—meningeal nodule and leptomeningeal enhancement | CSF cytology—no atypical cells At 27 months after diagnosis of LCM: protein—elevated, glucose—decreased CSF cytology—atypical cells consistent with metastatic SCC | Dexamethasone; dysimmune myelitis-Mycophenolate mofetil At 24 months after diagnosis of LCM: weekly ITMTX and MPS+ systemic chemotherapy with 3 weekly carboplatin and weekly cetuximab | Patient was alive at 6 months of the start of treatment of IV and IT chemotherapy |