P Beauchesne1, M Blonski, H Brissart. 1. Neuro-Oncologie - Neurologie, CHU de Nancy, Hôpital Central, CO n°34, 54035 Nancy cedex, France. beauchesneP@wanadoo.fr
Abstract
UNLABELLED: Secondary diffuse leptomeningeal gliomatosis, in which a glioma of the brain or spinal cord infiltrates the leptomeninges, is an uncommon clinical metastatic complication of malignant glioma, for which there is no consensus regarding treatment. In an ante mortem series in which the diagnosis of leptomeningeal gliomatosis was based on neuroradiological results, an incidence of 2% was reported. The appearance of leptomeningeal gliomatosis is a pre-terminal event. CASE REPORT: A 44 year-old woman rapidly developed intracranial pressure and impairment of cognitive function. A huge right temporal tumor was diagnosed and an incomplete resection performed. Histology showed it was a glioblastoma and a concurrent radiation therapy with temozolomide was administered. Her clinical status was subnormal. A first course of adjuvant chemotherapy, temozolomide, was administered, and her neurological status suddenly worsened in days: deterioration of cognitive function status, inability to walk, and aphasia were reported. The cerebrospinal fluid showed an elevated protein content of 2 g/l, and glucose concentration was low. Cytology of cerebrospinal fluid showed no malignant cells. Systemic nitrosourea chemotherapy (fotemustine) was administered. Intrathecal sustained-release cytarabine, Depocyt®, was initiated (an induction cycle followed by a consolidation). After a second intrathecal infusion, her clinical status significantly improved, and she was discharged to a medical unit. The duration of response was approximately 6 months. CONCLUSION: Intrathecal infusions of Depocyt®, recommended for the treatment of lymphoma neoplastic meningitis, seems to be effective in treatment of secondary diffuse leptomeningeal gliomatosis.
UNLABELLED: Secondary diffuse leptomeningeal gliomatosis, in which a glioma of the brain or spinal cord infiltrates the leptomeninges, is an uncommon clinical metastatic complication of malignant glioma, for which there is no consensus regarding treatment. In an ante mortem series in which the diagnosis of leptomeningeal gliomatosis was based on neuroradiological results, an incidence of 2% was reported. The appearance of leptomeningeal gliomatosis is a pre-terminal event. CASE REPORT: A 44 year-old woman rapidly developed intracranial pressure and impairment of cognitive function. A huge right temporal tumor was diagnosed and an incomplete resection performed. Histology showed it was a glioblastoma and a concurrent radiation therapy with temozolomide was administered. Her clinical status was subnormal. A first course of adjuvant chemotherapy, temozolomide, was administered, and her neurological status suddenly worsened in days: deterioration of cognitive function status, inability to walk, and aphasia were reported. The cerebrospinal fluid showed an elevated protein content of 2 g/l, and glucose concentration was low. Cytology of cerebrospinal fluid showed no malignant cells. Systemic nitrosourea chemotherapy (fotemustine) was administered. Intrathecal sustained-release cytarabine, Depocyt®, was initiated (an induction cycle followed by a consolidation). After a second intrathecal infusion, her clinical status significantly improved, and she was discharged to a medical unit. The duration of response was approximately 6 months. CONCLUSION: Intrathecal infusions of Depocyt®, recommended for the treatment of lymphoma neoplastic meningitis, seems to be effective in treatment of secondary diffuse leptomeningeal gliomatosis.