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Leptomeningeal Disease from Oligodendroglioma: Clinical and Molecular Analysis

Published online by Cambridge University Press:  02 December 2014

Gloria Roldán ,
James Scott ,
David George ,
Ian Parney ,
Jacob Easaw ,
Gregory Cairncross ,
Peter Forsyth  and
Elizabeth Yan
Gloria Roldán
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Calgary, Alberta, Canada
James Scott
Affiliation:
Department of Clinical Neurosciences, University of Calgary Department of Diagnostic Imaging, University of Calgary
David George
Affiliation:
Department of Pathology & Lab Medicine, University of Calgary
Ian Parney
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Calgary, Alberta, Canada
Jacob Easaw
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Clark Smith Integrated Brain Tumor Research Centre, Calgary, Alberta, Canada
Gregory Cairncross
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Calgary, Alberta, Canada
Peter Forsyth*
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Calgary, Alberta, Canada
Elizabeth Yan
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Clark Smith Integrated Brain Tumor Research Centre, Calgary, Alberta, Canada
*
Clark Smith Brain Tumor Center, Rm. 2AA19 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
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Abstract

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Background:

Leptomeningeal disease (LMD) is a late complication of malignant glioma, mostly of glioblastoma, that usually responds poorly to treatment and is rapidly fatal. A long surviving case led us to review our experience with LMD in patients with oligodendrogliomas.

Methods:

A 15-year retrospective chart review was performed. Patients with both oligodendroglial tumors and LMD were identified. A single neuro-pathologist reviewed all histological sections, a single neuro-radiologist reviewed all available images and lp/19q status was assessed.

Results:

Seven out of 145 patients with oligodendroglioma were diagnosed with LMD. Six were male. Median age at tumor diagnosis was 41 years (range, 28-50). None had radiographic or pathological evidence of leptomeningeal or subependymal tumor at initial diagnosis. Most patients had pure anaplastic oligodendrogliomas (4/7); 6/7 had 1p/19q co-deletion. The median time to first relapse was 41 months (range, 19-127). The median time to LMD was 76 months (range, 19-151) from initial diagnosis and 28 months (range, 0-36) from first relapse, respectively. Leptomeningeal disease treatments included spinal radiation and intrathecal and systemic chemotherapy. After progression, some patients with LMD remained stable clinically. The median survival from initial diagnosis was 104 months (range, 19-183) and from LMD diagnosis was 32 months (range, 2-43).

Conclusion:

Leptomeningeal disease is a complication of oligodendroglioma that may occur preferentially in long surviving patients with 1p/19q co-deletion. Leptomeningeal disease in patients with oligodendrogliomas appears to be relatively indolent which may have implications for their treatment and be related to 1p/19q status.

résumé:

<span class='bold'>RÉSUMÉ:</span> <span class='bold'> <span class='italic'>Contexte:</span></span>

Une atteinte des leptoméninges (ALM) est une complication tardive du gliome malin, surtout du glioblastome, qui répond habituellement peu au traitement et qui est rapidement fatale. L’observation d’un patient dont la survie a été longue nous a amenés à réviser notre expérience concernant l’ALM chez des patients porteurs d’un oligodendrogliome.

<span class='bold'> <span class='italic'>Méthodes:</span></span>

Nous avons procédé à une revue rétrospective de dossiers sur une période de 15 ans. Les patients atteints de tumeurs oligodendrogliales et d’ALM ont été identifiés. Un seul neuropathologiste a révisé toutes les coupes histologiques et un seul neuroradiologiste a revu toute l’imagerie. Le statut 1p/19q a été déterminé.

<span class='bold'> <span class='italic'>Résultats:</span></span>

Un diagnostic d’ALM a été posé chez 7 des 145 patients porteurs d’un oligodendrogliome. Six de ces 7 patients étaient des hommes. L’âge médian au moment du diagnostic de la tumeur était de 41 ans (écart de 28 à 50 ans). Aucun n’avait de signes radiologiques ou anatomopathologiques d’envahissement des leptoméninges ou d’envahissement sous–épendymaire au moment où le diagnostic initial a été posé. La plupart des patients étaient porteurs d’oligodendrogliomes anaplasiques pures (4/7); 6/7 avaient une co–délétion 1p/19q. Le temps médian du traitement initial jusqu’à la première rechute était de 41 mois (écart de 19 à 127 mois). Le temps médian du diagnostic initial et de la première rechute jusqu’à l’ALM était de 76 mois (écart de 19 à 151 mois) et de 28 mois (écart de 0 à 36 mois) respectivement. Les patients ayant une ALM ont été traités par irradiation spinale et chimiothérapie intrathécale et systémique. Certains patients ayant une ALM sont demeurés stables au point de vue clinique. La survie médiane à partir du moment du diagnostic initial était de 104 mois (écart de 19 à 183 mois) et à partir du moment du diagnostic d’ALM elle était de 32 mois (écart de 2 à 43 mois).

<span class='bold'> <span class='italic'>Conclusion:</span></span>

L’ALM est une complication de l’oligodendrogliome qu’on rencontre surtout chez les patients dont la survie est longue et qui sont porteurs d’une co–délétion 1p/19q. L’ALM chez les patients atteints d’oligodendrogliome semble relativement indolente ce qui peut avoir des implications pour le traitement et être relié au statut 1p/19q.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 2 , May 2008 , pp. 204 - 209
Copyright
Copyright © The Canadian Journal of Neurological 2008

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