Spinal leptomeningeal disease in patients with solid tumors: A single-center study on clinical presentation, diagnosis, treatment, and outcomes.

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, 67.3% 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.