Meningeal carcinomatosis in solid tumors

Area of Science:

• Neurology
• Oncology
• Pathology

Background:

• Metastatic tumor involvement of the leptomeninges, known as meningeal carcinomatosis (MC), occurs in solid tumors and lymphoproliferative diseases.
• MC is most prevalent in breast cancer, lung cancer, and melanoma, with adenocarcinoma being the predominant histological subtype.
• Typically a late-stage complication, MC presents with multifocal neurological signs and symptoms, indicating disseminated and progressive disease.

Purpose of the Study:

• To review the characteristics, diagnosis, treatment, and prognosis of meningeal carcinomatosis.
• To highlight the impact of novel systemic therapies and advanced neuroimaging on the detection and management of MC.

Main Methods:

• Diagnostic evaluation integrates clinical presentation, cerebrospinal fluid (CSF) analysis, and neuroimaging studies.
• Treatment strategies include systemic therapies for overall disease control and intrathecal chemotherapy as a primary local treatment.
• Prognostic factors considered include patient performance status and the extent of systemic disease.

Main Results:

• Improved systemic disease control with newer therapeutic agents contributes to an increasing incidence of metastatic evolution to the leptomeninges.
• Neuroimaging advancements enhance the detection and diagnosis of meningeal carcinomatosis.
• Intrathecal chemotherapy is the mainstay of treatment, often providing palliative benefits.

Conclusions:

• Meningeal carcinomatosis is a serious complication of advanced cancers, requiring a multidisciplinary diagnostic and therapeutic approach.
• While prognosis remains guarded, a higher performance status may identify patients with a potentially more favorable outcome.
• Ongoing research into systemic and local therapies is crucial for improving patient management and outcomes in meningeal carcinomatosis.