Leptomeningeal metastases in a real-life setting of an oncology center – clinical presentation and neuroimaging features

Neurological complications of oncological diseases remain a significant problem, affecting patient survival and quality 
of life.

Objective: To analyze the variability of clinical features in patients with leptomeningeal metastasis (LMM), considering the 
cytological and neuroimaging characteristics of nervous system involvement; to identify statistically significant differences 
between patients with type I and type II LMM

Materials and Methods. In this single-center retrospective cohort study, we retrieved clinical, neuroimaging, and 
laboratory (including cerebrospinal fluid findings) data for 51 patients receiving care for solid tumors and hematological 
malignancies at our institution between 2021 and 2023. Patients were stratified into two groups, according to leptomeningeal 
disease type, as stated in the EANO-ESMO recommendations. Statistical analysis was performed by means of SPSS 23.0.

Results. During the observation period, the diagnosis of leptomeningeal metastasis (LMM) was verified in 51 patients, 
the majority of whom had solid tumors (n=47; 92.1%). Most patients suffered from breast cancer (n=16; 31.4%), lung cancer 
(n=14; 27.5%), and melanoma (n=6; 11.8%). Type I LMM was diagnosed in 21 cases (n=21; 41.2%), while type II LMM was 
diagnosed in 30 cases (n=30; 58.8%). When comparing clinical features in patients with type I and type II LMM, statistically 
significant differences were confirmed for the following parameters: peripheral nervous system involvement (p=0.003), 
cranial neuropathy (p=0.001), altered consciousness (p=0.009), and speech impairment (p=0.02), which were significantly 
more frequent in patients with type I LMM in this cohort. The final distribution of patients across radiological categories 
of LMM was as follows: category A (n=22; 43.1%), category B (n=6; 11.7%), category C (n=15; 29.4%), and category D (n=8; 
15.7%). Notably, patients with type I LMM had a significantly higher occurrence of category D.

Conclusion. The analysis emphasizes the importance of early diagnosis and a personalized approach to each clinical 
case, taking into account the diversity of manifestations of leptomeningeal metastasis (LMM). The study demonstrates that, 
despite existing diagnostic criteria, a significant number of patients may present atypical symptoms. This work provides 
a basis for further research aimed at gaining a deeper understanding of this disease and developing effective diagnostic 
methods for this patient group.

Conflict of interest. This study had no sponsorship. Authors declare no conflict of interest. The authors are fully 
responsible for submitting the final version of the manuscript. All the authors took part in the development of the concept 
of the article and the writing of the manuscript. All authors approved the final version of the manuscript.