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Brain metastasis from advanced gastric cancers: Leptomeningeal metastasis and its clinical impact on survival
J Korean Skull Base Soc 2024;19(2):93-102
Published online October 31, 2024
© 2024 Korean Skull Base Society.

Seoyun Lee1, Eui Hyun Kim1,2

1Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
2Brain Tumor Center, Severance Hospital, Seoul, Korea
Correspondence to: Eui Hyun Kim
E-mail euihyunkim@yuhs.ac
ORCID https://orcid.org/0000-0002-2523-7122
Received August 13, 2024; Revised September 2, 2024; Accepted September 4, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Gastric cancer is one of the most common and fatal cancers worldwide, however, brain metastasis from gastric cancer is very rare. Leptomeningeal metastasis (LMM) is well known for its devastating prognosis and mortality, critical cause that leads patients diagnosed with brain metastasis to death. Therefore, to improve overall survival of patients with brain metastasis from gastric cancer, LMM in gastric cancer should be essentially dealt with.
Materials and Methods: We reviewed our 128 patients diagnosed with gastric cancer with brain metastasis. We identified 74 patients presented evidences of LMM. We evaluated whether patient characteristics, treatment modalities determine survival outcome both in the group of entire 128 patients and in the group of 72 patients with LMM.
Results: Overall survival of LMM group was significantly shorter than that of non-LMM group. Among LMM group, overall survival of pure LMM group with no parenchymal metastasis was significantly shorter than that of non-pure LMM group with parenchymal metastasis. On all 128 patients, those treated with tumor removal followed by whole brain radiotherapy (WBRT) showed superior overall survival than WBRT alone. On 74 LMM patients, those who underwent WBRT combined with intrathecal methotrexate showed better outcome than WBRT only. Specifically, on 51 pure LMM patients, same trend was reported, and the former treatment showed better outcome than the latter.
Conclusions: Targeting LMM rather than parenchymal metastasis will be more critical. we should continue searching for the best strategy and key regimens that can significantly target LMM, maximizing the therapeutic effect and minimizing neurotoxicity.
Keywords : Advanced gastric cancer, Brain metastasis, Intrathecal chemotherapy, Leptomeningeal metastasis, Whole brain radiotherapy

October 2024, 19 (2)
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