August 12, 2025Open Access

Supc-01 Survival and Prognostic Factors in Hospitalized Patients With Leptomeningeal Disease: A Retrospective Review of Palliative Radiotherapy

Key Points

Overall survival after palliative radiotherapy for leptomeningeal disease was just 2.18 months, indicating a dire prognosis for affected patients.
Statistical analysis revealed that variables like positive cytology and Karnofsky performance status significantly impact overall survival in those receiving treatment.
Retrospective chart review documented inpatient radiotherapy consultations from November 2022 to December 2024, focusing on symptomatic management and quality of life.
The findings emphasize the need for better patient stratification and larger studies to guide future treatment approaches for leptomeningeal disease.

Abstract

Abstract BACKGROUND Leptomeningeal disease (LMD) is associated with poor prognosis, and effective management requires a multidisciplinary approach. Limited data exist on stratifying patients for therapy and prognosis. We endeavor to describe our inpatient radiotherapy (RT) experience with LMD and identify prognostic factors to guide palliative therapeutic interventions. METHODS A retrospective chart review of inpatient RT consultations was conducted from November 2022 to December 2024. History and symptoms, hospital course, imaging, therapeutic interventions, performance status, labs, and death date were collected. RStudio was utilized for statistical analyses. RESULTS Patients presented with acute neurologic deficits and were subsequently diagnosed with LMD via imaging followed by an inpatient multi-disciplinary evaluation. We triaged and recommended palliative/involved field RT in 64 LMD consults; median age 59 (range 24-82) and median KPS 60 (range 40-90). RT consisted of involved field (whole brain, partial spine, or both) with 8-35Gy/1-13Fx. Median overall survival (OS) after RT: 2.18 months (range 0.3-20.63), stratified by: breast 3.4 (0.3-17) vs non-breast 1.8 (0.3-20.6), NCCN status: Good 1.9 (0.3-9.4) vs Poor 2.28 (0.4-20.6). Hospitalization duration, albumin, positive cytology, diffuse LMD (brain and spine involvement), KPS, NCCN Poor-status, non-breast primary cancer, prior hospitalizations, age, and hepatic metastases were associated with worse OS and statistically significant on univariate analysis and on multivariate analysis all variables were also significant (p-value: 0.031). CONCLUSIONS Our data underscores the poor OS of LMD in hospitalized symptomatic patients treated with palliative RT. Treatment tailored for symptom management, prioritizing quality of life, may be appropriate for these patients. As the treatment paradigm of LMD evolves with improvements in drug therapy and technology, so does the need for better patient selection. Larger cohorts are needed to better understand the factors impacting survival and to develop prognostic metrics to guide treatment strategies.

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