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Published on: July 5, 2021
Management of neoplastic meningitis
Patrick Roth1, Michael Weller2
1Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland. patrick.roth@usz.ch.
Abstract:
Leptomeningeal dissemination of tumor cells, also referred to as neoplastic meningitis, is most frequently seen in patients with late-stage cancer and mostly associated with a poor prognosis. Basically, neoplastic meningitis may affect all patients with a malignant tumor but is most common in patients affected by lung cancer, breast carcinoma, melanoma or hematologic neoplasms such as lymphoma and leukemia. Controlled clinical trials are largely lacking which results in various non-standardized treatment regimens. The presence of solid tumor manifestations in the CNS as well as the extracranial tumor load defines the most appropriate treatment approach. Radiation therapy, systemic chemotherapy and intrathecal treatment must be considered. For each patient, the individual situation needs to be carefully evaluated to determine the potential benefit as well as putative side effects associated with any therapy. A moderate survival benefit and particularly relief from pain and neurological deficits are the main treatment goals. Here, we summarize the management of patients with neoplastic meningitis and review the available treatment options.
Insights
Neoplastic meningitis, or leptomeningeal dissemination, affects late-stage cancer patients, often with poor outcomes. Treatment focuses on personalized approaches to improve survival and alleviate symptoms.
Area of Science:
- Oncology
- Neurology
- Cancer Metastasis
Background:
- Leptomeningeal dissemination (neoplastic meningitis) is a serious complication of advanced cancer, frequently associated with poor prognosis.
- It most commonly affects patients with lung cancer, breast carcinoma, melanoma, lymphoma, and leukemia.
- Lack of controlled clinical trials leads to non-standardized treatment regimens.
Purpose of the Study:
- To summarize the management strategies for patients diagnosed with neoplastic meningitis.
- To review the available treatment options for leptomeningeal carcinomatosis.
- To emphasize individualized treatment planning based on tumor burden and patient status.
Main Methods:
- Review of existing literature and clinical guidelines for neoplastic meningitis management.
- Analysis of treatment approaches including radiation therapy, systemic chemotherapy, and intrathecal treatment.
- Evaluation of factors influencing treatment decisions, such as CNS and extracranial tumor load.
Main Results:
- Treatment decisions are guided by the extent of solid tumor manifestations in the central nervous system (CNS) and overall extracranial tumor burden.
- Therapeutic options include radiation therapy, systemic chemotherapy, and intrathecal treatment.
- Individual patient evaluation is crucial to balance potential benefits against treatment-related side effects.
Conclusions:
- The primary goals of managing neoplastic meningitis are moderate survival benefit and significant relief from pain and neurological deficits.
- Personalized treatment strategies are essential for optimizing outcomes in patients with leptomeningeal dissemination.
- Further research and controlled trials are needed to standardize treatment protocols.
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