Abstract Details

Title Leptomeningeal Dissemination After GammaTile and LITT in High Grade Astrocytoma Patients

Topic Neuro-oncology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-004

Objective

To present cases of leptomeningeal dissemination (LMD) after localized treatment with GammaTile or laser interstitial thermal therapy (LITT) in patients with high grade astrocytoma.

Background LMD occurs primarily in glioblastoma patients with prolonged survival and those who undergo aggressive treatment courses. Targeted therapies such as GammaTile (which contains cesium-131 radiation emitting seeds) or LITT provide good localized disease control following recurrence and serve as immediate treatment in the weeks leading up to radiotherapy or systemic treatment. Here we present a case series of patients who received localized therapy with GT or LITT who soon thereafter developed LMD.

Design/Methods We retrospectively reviewed all patients at our institution with high grade astrocytoma who were treated with either GammaTile or LITT and were later found to have disseminated disease into the leptomeningeal space. DNA/RNA sequencing, NGS and immunohistochemistry of tumor tissue were performed at both original diagnosis and time of GammaTile placement or LITT procedure. LMD was diagnosed through MRI brain/spine findings. Cases were analyzed for time to development of leptomeningeal dissemination, median overall survival, survival from time of leptomeningeal dissemination diagnosis, and time of leptomeningeal dissemination diagnosis to second radiation therapy.

Results Out of 90 high grade astrocytoma patients treated with GammaTile therapy or LITT following recurrence, 5 had progression to leptomeningeal dissemination. Two patients had multifocal tumor, and another had contralateral progression prior to LMD. The median overall survival after leptomeningeal dissemination was 6.5 months (range 0.1–28.5) for astrocytoma and only 3.8 months (range 0.1–32.6) for glioblastoma.

Conclusions

Leptomeningeal dissemination is a devastating complication of aggressive gliomas who receive only localized therapy. Systemic therapy is needed following localized therapies to control disease. Further research into new therapies and techniques for treatment is needed to allow for better outcomes.

Authors/Disclosures
Tabarak M. Mian, MD (UT Southwestern Medical Center) PRESENTER	Dr. Mian has nothing to disclose.
Rosalina Magalhaes Pereira, MD (MSKCC)	Dr. Magalhaes Pereira has nothing to disclose.
Toral Patel (UT Southwestern Medical Center)	Toral Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Toral Patel has received intellectual property interests from a discovery or technology relating to health care.
Tu Dan, MD	Dr. Dan has nothing to disclose.
Michael Youssef, MD (UT Southwestern Medical Center)	Dr. Youssef has nothing to disclose.

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