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Leptomeningeal carcinomatosis in gastric cancer: A Review

  • 0Department of Internal Medicine, Montefiore Medical Center Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA.
Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association +

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March 14, 2025

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March 14, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Leptomeningeal carcinomatosis (LM) is rare in gastric cancer but fatal. Diagnosis requires high suspicion, and treatment involves intrathecal chemotherapy and radiation, with a median survival of only two months.

Area Of Science

  • Oncology
  • Neurology
  • Gastroenterology

Background

  • Gastric cancer is a leading cause of cancer death globally.
  • Leptomeningeal carcinomatosis (LM) is a rare but severe complication of gastric cancer, affecting approximately 0.06% of patients.
  • Managing LM in gastric cancer presents challenges due to its rarity, impacting trial design and treatment standardization.

Purpose Of The Study

  • To provide a comprehensive resource for oncologists managing leptomeningeal carcinomatosis in gastric cancer patients.
  • To analyze recent cases of LM in gastric cancer to inform diagnostic and therapeutic strategies.
  • To highlight the critical need for early suspicion and timely intervention in gastric cancer patients with suspected leptomeningeal disease.

Main Methods

  • A review and analysis of 47 recent cases of leptomeningeal carcinomatosis in gastric cancer.
  • Evaluation of diagnostic modalities including cerebrospinal fluid (CSF) cytology and MRI.
  • Assessment of treatment strategies, including radiation, intrathecal chemotherapy (methotrexate), and systemic therapy.

Main Results

  • Cerebrospinal fluid (CSF) cytology is the gold standard for diagnosing LM, with MRI as the preferred imaging modality.
  • Diagnosis can be challenging, often requiring repeated lumbar punctures and imaging; negative results do not exclude LM.
  • Treatment with intrathecal methotrexate (commonly 10-12 mg) and radiation therapy is standard, with median survival of 2 months (maximum 12 months).

Conclusions

  • High clinical suspicion for leptomeningeal disease is crucial in gastric cancer patients presenting with relevant symptoms.
  • Further prospective studies are needed to evaluate biweekly to bi-monthly treatment schedules and the addition of systemic therapy to intrathecal treatment.
  • In the absence of definitive data, intrathecal chemotherapy and radiation should be considered for patients with a performance status suitable for treatment.

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