Neoplastic meningitis

Neoplastic meningitis (NM) occurs in approximately 5% of all patients with cancer. NM is a disease affecting the entire neuraxis, so staging and treatment need to encompass all cerebrospinal fluid (CSF) compartments. Central nervous system staging of NM includes contrast-enhanced brain and spine imaging and radionuclide CSF flow study. Treatment of NM incorporates involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with NM and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (ie, methotrexate, cytosine arabinoside, and thiotepa) administered on a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of NM is palliative, with an expected median patient survival of 3 to 6 months, it often affords stabilization and protection from further neurologic deterioration in patients with NM.