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Location: Marriott Marquis
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PQA 04 - PQA 04 Palliative Care and Central Nervous System Poster Q&A

2494 - Clinical Outcomes and Toxicities Associated with Radiation Therapy for Patients with Leptomeningeal Dissemination of Primary Gliomas

Monday, September 30, 2024
10:45 AM – 12:00 PM ET
Location: Hall C

Screen: 19

A. N. Chavana1, C. A. Faraj2, T. Beckham3, M. C. Tom3, B. De3, C. Wang3, W. Jiang Jr4, T. A. Swanson3, D. N. Yeboa3, A. J. Ghia3, A. C. Paulino3, M. F. F. McAleer3, S. L. McGovern3, J. Li3, J. S. Weinberg5, C. B. Patel2, and S. Perni3; 1Baylor College of Medicine, Houston, TX, 2Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 5Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Leptomeningeal disease (LMD) associated with primary gliomas is uncommon but aggressive. Clinical outcomes of patients with glial LMD are not well characterized, and optimal radiation treatment paradigms are unknown. We aimed to describe the clinical course of patients treated with radiation therapy (RT) for glial LMD. Materials/

Methods: This IRB-approved, single-institution, retrospective study included patients with gliomas affecting the brain and/or spinal cord with radiographic LMD. Demographic, clinical, and RT treatment data were abstracted from electronic medical records. Gliomas were graded according to WHO 2016 criteria. Reported toxicities following RT were abstracted from clinical notes and laboratory reports and graded using the Common Terminology Criteria for Adverse Events (CTCAE) applicable at that time point. Kaplan Meier calculations and Cox proportional hazards modeling were used to estimate overall survival (OS) and conduct univariate analyses, respectively.
Results: We identified 74 patients with glial LMD, of which the majority were male (68.9%) and white (75.7%) with a median age of 53 (range: 5-79) years. Most patients had WHO 2016 grade 4 tumors (91.9%), specifically glioblastoma (87.8%). LMD was present in 14 patients at initial diagnosis (18.9%). Patients had radiographic LMD involving brain (n=39, 52.7%), spine (n=17, 23.0%), or both (n=18, 24.3%). Of patients with available RT data (n=55), 25.5% received proton craniospinal irradiation. Three patients (5.4%) received whole brain RT, six (10.9%) received focal spinal RT, and 41 (74.5%) received focal brain RT. Twelve patients (21.8%) received multiple RT courses (range, 1-3). Median follow-up was 73.0 months, with median OS from diagnosis of 15.6 months (95% CI 12.8-20.3 months) and from development of LMD of 4.9 months (95% CI 3.3-6.1 months). On univariable analyses, only older age was associated with significantly decreased OS after LMD diagnosis (HR 1.02/year, 95% CI [1.01-1.04], p</span>=0.002). Grade =3 toxicities occurred in 5 patients (9.1%). Forty-seven patients had bloodwork drawn within 1 month of treatment cessation; grade =3 leukopenia (n=4, 8.5%), thrombocytopenia (n=3, 6.4%), neutropenia (n=1, 2.1%), and anemia (n=1, 2.1%) were rare.
Conclusion: In this preliminary retrospective experience of patients with LMD from primary gliomas, patients had limited survival after development of LMD, but had minimal toxicity associated with RT regimens. Further study is warranted to determine optimal management for patients with this rare but aggressive disease process.