Isolated leptomeningeal progression from sinonasal carcinomas: Implications for staging workup and treatment

Head Neck. 2019 Aug;41(8):2647-2654. doi: 10.1002/hed.25741. Epub 2019 Mar 25.


Purpose: To evaluate the rate and risk factors of isolated leptomeningeal progression in sinonasal carcinomas.

Methods: We retrospectively reviewed imaging and clinical records to determine progression patterns, and estimated rates using the Kaplan-Meier method. We evaluated risk factors using proportional hazard regression.

Results: We analyzed 120 patients who received adjuvant or primary radiotherapy for sinonasal carcinomas. Most patients had T4 disease (68%) and underwent surgery (84%) and chemotherapy (72%). Twenty-seven (23%) patients developed distant metastases (DM), including 20 (17%) with isolated DMs. Leptomeningeal progression was the most common site of isolated DMs (n = 9; 45%) with an average disease-free interval of 1.2 years (0.1-4.3 years). High-grade histology (P = 0.0003), intracranial invasion (P < 0.0001), and neuroendocrine histology (P = 0.06) were associated with increased risk.

Conclusions: Isolated leptomeningeal progression is a common pattern of DM in advanced sinonasal carcinomas. We recommend adding cerebrospinal fluid cytology and contrast-enhanced spine MRI to routine staging evaluations for high-risk patients.

Keywords: distant metastases; leptomeningeal progression; radiotherapy; retrospective; sinonasal carcinomas.

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy
  • Disease Progression
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Meningeal Neoplasms / pathology*
  • Middle Aged
  • Neoplasm Invasiveness*
  • Paranasal Sinus Neoplasms / pathology*
  • Paranasal Sinus Neoplasms / therapy
  • Radiotherapy
  • Retrospective Studies
  • Risk Factors
  • Young Adult