Table of Contents
Scholarly Research Exchange
Volume 2009 (2009), Article ID 642154, 6 pages
http://dx.doi.org/10.3814/2009/642154
Case Report

Leptomeningeal Carcinomatosis Secondary to Gastroesophageal Adenocarcinoma: A Case Report and Literature Review of a Rare Occurrence

1Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
2Department of Medical Oncology, North York General Hospital, Toronto, ON, M2R 1N5, Canada
3Department of Pathology, North York General Hospital, Toronto, ON, M2R 1N5, Canada
4Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada

Received 23 August 2008; Revised 24 October 2008; Accepted 17 February 2009

Copyright © 2009 Gunita Mitera et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present a 68-year-old male with leptomeningeal carcinomatosis (LC) from gastroesophageal junction carcinoma. Three months following epirubicin, cisplatin, 5-flurouracil (ECF) chemotherapy, the patient suffered from gait imbalance, headache, and dysarthria. CT and MRI imaging revealed LC throughout the brain and spine. The patient was prescribed dexamethasone and treated with a course of palliative radiation to the whole brain, 2000cGy/5. Additionally, the regions of symptomatic disease in the spine included the top of L4 vertebrae to the bottom of the S2 vertebrae which was treated with 2000cGy/5, and the top of the C5 vertebrae to the bottom of the T4 vetebrae received 800cGy/1. The radiation treatment did provide short-term symptom control; however, the patient eventually passed away from his illness. While LC remains a devastating complication of malignant disease, it has been rarely discussed in GI tumors, specifically GE junction adenocarcinomas. Therefore treatment options must be considered using first principles based on management of LC in more common disease sites. With early detection, and for patients with good performance status, palliative radiation utilizing hypofractionated regimens to sites of symptomatic involvement may improve quality of life for this group of unfortunate people.