Related Experiment Video
Updated: Jun 21, 2026
Minimally Invasive Cisterna Magna Injection Model for Leptomeningeal Metastasis Studies in Mice
Published on: May 23, 2025
Treatment modalities for leptomeningeal metastases
William R Shapiro1, Conrad E Johanson, Willem Boogerd
1Division of Neurology, Director Neuro-Oncology Program, Barrow Neurological Institute, Phoenix, AZ 85013, USA. wshapiro@chw.edu
Abstract:
Secondary involvement of the leptomeninges represents an infrequent but devastating (and nearly always fatal) complication of solid tumors, hematologic malignancies (both leukemia and lymphoma), and primary brain tumors. Clinical suspicion of neoplastic meningitis (NM) may be raised by the appearance of multivariate neurological symptoms; however, a definitive diagnosis is often difficult to obtain. Improved treatments for primary malignancies and advances in diagnostic imaging technology have led to an apparent increase in the number of patients diagnosed with NM. Unfortunately, therapeutic options remain limited, particularly for patients with chemoresistant tumors. Optimized treatment remains controversial and may rely upon a combination of chemotherapy (intrathecal and/or intravenous) and concurrent focal radiotherapy. This review discusses the advantages and disadvantages of intra-cerebrospinal fluid (CSF) versus systemic strategies for treating NM. Clinical trial evidence is presented for the different treatment modalities. In addition, the therapeutic potential of intra-CSF therapy for cancer prophylaxis is discussed. Earlier diagnosis and more aggressive preventive treatment regimens may provide substantial increases in survival and favorably affect quality of life. Additional data from large-scale, well-controlled trials are required to more accurately assess the efficacy of intra-CSF versus systemic treatment in NM. Future treatment options using novel targets for intra-CSF therapy will be addressed as well.
Insights
Neoplastic meningitis (NM) is a rare but severe complication of cancer. This review explores intra-cerebrospinal fluid (CSF) versus systemic treatments for NM, highlighting the need for earlier diagnosis and improved therapies.
Area of Science:
- Neuro-oncology
- Medical oncology
- Clinical neurology
Background:
- Neoplastic meningitis (NM) is a rare, often fatal complication of solid tumors, hematologic malignancies, and primary brain tumors.
- Diagnosis can be challenging despite neurological symptoms, but advances in imaging and cancer treatment have increased reported cases.
- Limited therapeutic options exist, especially for chemoresistant tumors, making treatment controversial.
Purpose of the Study:
- To review the advantages and disadvantages of intra-cerebrospinal fluid (CSF) versus systemic treatment strategies for neoplastic meningitis (NM).
- To present clinical trial evidence for various NM treatment modalities.
- To discuss the therapeutic potential of intra-CSF therapy for cancer prophylaxis and future novel targets.
Main Methods:
- Literature review of existing clinical trial data and therapeutic strategies for neoplastic meningitis.
- Comparative analysis of intra-CSF and systemic treatment approaches.
- Discussion of diagnostic challenges and emerging treatment potentials.
Main Results:
- Treatment for NM often involves a combination of chemotherapy (intrathecal/intravenous) and radiotherapy.
- Evidence for intra-CSF versus systemic treatment efficacy requires further large-scale, controlled trials.
- Early diagnosis and aggressive preventive treatment may improve survival and quality of life.
Conclusions:
- Optimized treatment for NM remains controversial, with ongoing debate regarding the best therapeutic strategies.
- Further research, including large-scale trials, is crucial to determine the optimal efficacy of intra-CSF versus systemic treatments.
- Novel targets for intra-CSF therapy hold promise for future treatment advancements in NM.
