The treatment of neoplastic meningitis

Neoplastic meningitis (NM) is a debilitating complication of cancer that occurs when tumour cells infiltrate the leptomeninges. Treatment often includes direct installation of chemotherapy into the cerebrospinal fluid either by lumbar puncture or the use of a ventricular reservoir, radiation therapy, systemic chemotherapy or a combination of these modalities. The current standard chemotherapeutic agents for direct instillation into the cerebrospinal fluid include methotrexate, cytarabine and thiotepa. Other agents, such as topotecan, manfosfamide and IFNs, are undergoing evaluation in clinical trials. Despite active investigation of new therapies, the prognosis for patients with NM remains poor. However, some patients do demonstrate improvement of neurological function and prolongation of survival with treatment. Therefore, careful evaluation and treatment planning is warranted in order to avoid treatment-associated toxicities and to maximise the impact of the treatment on the disease process.