[Treatment of the leptomeningeal metastases related to solid tumors]

The incidence of metastases of the central nervous system (CNS) is increasing, due to the improvement of the overall survival of cancer patients. Leptomeningeal metastases (LM) are now more often identified, although the criteria used for the diagnosis and monitoring remains inadequate. LM should be diagnosed at an early stage of the disease before the setting of neurological deficits, in order to improve the quality of life of patients. Therapeutic indications remain difficult, though some criteria have been proposed. Prolonged survivals have been reported even in the presence of identified poor prognostic factors at the time of the diagnosis of LM. The median survival of untreated patients is 4 to 6 weeks. Specific treatment may prolong survival by several months. Only six randomized studies are available. All theses studies have limitations due to the difficulty of including these patients in homogeneous trials, with a good methodology and for a time acceptable to the patient enrolment. The treatment requires a combination of chemotherapy and targeted therapies administrated systemically or via intra-cerebrospinal fluid (CSF) route, surgery and radiotherapy. Patient management is specific but requires a multidisciplinary approach, which may vary according to the characteristics of meningeal disease, the characteristics of primary tumors, the general condition of patients and previous lines of treatments. Our objective was to describe the current management of LM of solid tumors.