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Current diagnosis and treatment of leptomeningeal metastasis
1Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Abstract:
Meningeal metastasis occurs in 3-8% of all cancer patients, producing neurologic morbidity and a high mortality. Diagnosis is best established by the demonstration of malignant cells in the cerebrospinal fluid. However, in patients with known cancer, MR scan with gadolinium may be diagnostic when subarachnoid nodules can be demonstrated in the head or spine. Therapy usually involves radiotherapy to symptomatic sites, often followed by intrathecal chemotherapy. Intrathecal chemotherapy is best delivered by an intraventricular reservoir system but can also be delivered by repeated lumbar puncture. Methotrexate, cytarabine and thiotepa are the most common agents instilled into the subarachnoid space. Their limited efficacy can be explained by their restricted spectrum of antitumor activity. Patients with leptomeningeal metastasis from leukemia, lymphoma or breast cancer tend to respond best and this may, in part, be attributed to the relative sensitivity of these primary tumor types to the agents administered intrathecally. Systemic chemotherapy may prove a more attractive alternative to intrathecal drugs since it can penetrate into bulky disease, reach all areas of the subarachnoid space, and not be restricted by CSF bulk flow. The prognosis for patients with leptomeningeal metastasis is poor, most individuals surviving a median of only about four months. Occasional patients do have prolonged survival and improvement of their neurologic function.
Insights
Meningeal metastasis, cancer spread to the brain or spinal cord lining, causes severe symptoms and high mortality. Diagnosis and treatment, including intrathecal chemotherapy, offer limited efficacy, with poor prognosis for most patients.
Area of Science:
- Neuro-oncology
- Cancer Metastasis
Background:
- Meningeal metastasis affects 3-8% of cancer patients, causing significant neurological issues and mortality.
- Diagnosis relies on detecting malignant cells in cerebrospinal fluid or via MRI scans.
Purpose of the Study:
- To review the diagnosis, treatment, and prognosis of meningeal metastasis.
- To evaluate the efficacy of current therapeutic strategies.
Main Methods:
- Review of diagnostic methods including cerebrospinal fluid analysis and MRI.
- Discussion of therapeutic approaches: radiotherapy and intrathecal chemotherapy (methotrexate, cytarabine, thiotepa).
- Exploration of systemic chemotherapy as a potential alternative.
Main Results:
- Intrathecal chemotherapy has limited efficacy due to restricted antitumor activity.
- Leptomeningeal metastasis from leukemia, lymphoma, and breast cancer show better response rates.
- Systemic chemotherapy presents potential advantages in drug delivery and efficacy.
Conclusions:
- Prognosis for meningeal metastasis is generally poor, with a median survival of approximately four months.
- While occasional patients experience prolonged survival, further research into more effective treatments is warranted.