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Related Experiment Videos

Neoplastic meningitis.

Marc C Chamberlain1

  • 1Department of Neurology and Neurological Surgery, University of Southern California, Keck School of Medicine, Norris Comprehensive Cancer Center and Hospital, 1441 Eastlake Avenue, Room 3459, Los Angeles, CA 90033-0804, USA.

Seminars in Neurology
|January 8, 2005
PubMed
Summary
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Neoplastic meningitis, a cancer complication affecting the entire nervous system, requires comprehensive staging and treatment. Therapies include radiation and intra-cerebrospinal fluid (CSF) drug delivery, offering palliative care and neurological stabilization.

Area of Science:

  • Neuro-oncology
  • Neurology
  • Oncology

Background:

  • Neoplastic meningitis affects approximately 5% of cancer patients.
  • It is a disease of the entire neuraxis, necessitating comprehensive staging and treatment across all cerebrospinal fluid (CSF) compartments.
  • Focal signs and symptoms are frequent but do not represent the full extent of the disease.

Purpose of the Study:

  • To outline the staging and treatment modalities for neoplastic meningitis.
  • To discuss the role of systemic therapy in conjunction with intra-CSF drug therapy.
  • To highlight the palliative nature and expected outcomes of neoplastic meningitis treatment.

Main Methods:

  • Central nervous system staging involves advanced imaging: contrast-enhanced cranial CT/MRI, spine MRI/CT myelography, and radionuclide CSF flow studies.

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

    • Main Results:

    • Staging encompasses the entire neuraxis to assess disease extent.
    • Treatment strategies combine radiotherapy and intra-CSF chemotherapy.
    • Concomitant systemic therapy may enhance patient benefit and potentially reduce the need for intra-CSF chemotherapy.

    Conclusions:

    • Neoplastic meningitis requires a holistic approach to staging and treatment, considering the entire CSF system.
    • Current intra-CSF therapies are limited to three agents with palliative intent.
    • While palliative, treatment aims to stabilize neurological function and prevent further deterioration, with a median survival of 2-6 months.