Spinal Leptomeningeal Disease in Patients with Solid Tumors: A Single-Center Study on Clinical Presentation, Diagnosis, Treatment, and Outcomes

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ABSTRACT Introduction Despite affecting 5-15% of metastatic cancer patients, leptomeningeal disease (LMD), and spinal LMD (sLMD) in particular, remain largely understudied. Research question This study evaluates the clinical presentation, diagnosis, treatment, and outcomes of sLMD. Material and Methods We retrospectively analyzed sLMD patients treated at a tertiary center (2011–2024) who underwent cranial and spinal imaging within 30 days of LMD diagnosis. Survival analysis was performed using Kaplan-Meier curves, with a multivariable Cox regression model being employed to identify independent prognostic factors using a stepwise backwards approach. Results Fifty-two patients (median age: 57.9 years, 63.5% female) were included. Breast cancer (30.8%) and NSCLC (25.0%) were the most common primary malignancies. Median time from primary disease diagnosis to LMD diagnosis was 30.2 months [95% CI: 18.9-42.6]. LMD was diagnosed in 51.9% of cases through imaging and in 48.1% through imaging and CSF cytology. At diagnosis, 92.3% had concurrent cranial and spinal LMD, 69.2% brain metastases, 50.0% vertebral metastases, and 19.2% intraspinal metastases. The most common symptoms were clinical decline (80.8%) and headaches (59.6%). Spine-related symptoms included radiculopathy (26.9%), and paraplegia (23.1%). Median overall survival was 2.7 months [95% CI: 2.0-4.1]. Independent prognostic factors for improved survival included systemic therapy following LMD diagnosis (HR=0.40, p<0.01), absence of cranial nerve deficits (HR=0.45, p<0.05) and absence of gait imbalance (HR=0.50, p<0.05) at LMD diagnosis. Discussion and Conclusion By highlighting the clinical challenges, heterogenous treatment regimens and poor prognosis associated with sLMD, this study serves as a foundation for further research aimed at improving management strategies and outcomes for this patient cohort.

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