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Related Experiment Videos

Neoplastic meningitis.

Ana Aparicio1, Marc C Chamberlain

  • 1Department of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Center and Hospital, 1441 Eastlake Avenue, Room 3459, Los Angeles, CA 90033-0804, USA.

Current Neurology and Neuroscience Reports
|April 9, 2002
PubMed
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Neoplastic meningitis (NM) affects the entire nervous system, requiring comprehensive staging and treatment across all cerebrospinal fluid (CSF) compartments. Current palliative treatments aim to stabilize neurological decline in cancer patients with NM.

Area of Science:

  • Neuro-oncology
  • Neurology
  • Oncology

Background:

  • Neoplastic meningitis (NM) is a frequent complication in neuro-oncology, affecting approximately 5% of cancer patients.
  • NM impacts the entire neuraxis, necessitating a holistic approach to staging and treatment.
  • Focal neurological signs are common, but the disease's systemic nature requires consideration of all cerebrospinal fluid (CSF) compartments.

Purpose of the Study:

  • To outline the current staging and treatment strategies for neoplastic meningitis (NM).
  • To discuss the role of radiotherapy and intra-CSF chemotherapy in managing NM.
  • To explore the potential benefits of concomitant systemic therapy in NM patients.

Main Methods:

  • Central nervous system (CNS) staging involves advanced imaging techniques like contrast-enhanced MRI/CT of the brain and spine, and radionuclide CSF flow studies.

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  • Treatment includes involved-field radiotherapy for bulky or symptomatic disease.
  • Intra-CSF drug therapy utilizes methotrexate, cytosine arabinoside, or thio-triethylene thiophosphoramide via intralumbar or intraventricular delivery.

    • Main Results:

    • Staging requires comprehensive assessment of the entire CNS, including CSF compartments.
    • Treatment combines radiotherapy and intra-CSF chemotherapy, with potential benefits from systemic therapies.
    • Intra-CSF chemotherapy is limited to three agents with varied administration schedules.

    Conclusions:

    • Neoplastic meningitis (NM) management requires a multimodal approach encompassing the entire neuraxis.
    • While palliative, current treatments can stabilize neurological function and prevent further deterioration.
    • Systemic therapies may enhance outcomes and potentially reduce the need for intra-CSF chemotherapy.