Leptomeningeal metastasis Journal Article
| Authors: | De Angelis, L. M.; Boutros, D. |
| Article Title: | Leptomeningeal metastasis |
| Abstract: | Leptomeningeal metastasis is a common complication of cancer. Often the diagnosis can be difficult, but early diagnosis and aggressive treatment can prevent irreversible neurologic deficits. Diagnosis is usually established by the demonstration of malignant cells in the cerebrospinal fluid (CSF) or by the presence of enhancing tumor nodules on cranial or spinal MRI. Treatment may require focal radiotherapy to symptomatic sites accompanied by chemotherapy. Intra-CSF chemotherapy requires normal CSF flow dynamics and is typically limited to the use of methotrexate, cytarabine or thiotepa. Intrathecal chemotherapy is rarely efficacious, except for hematopoietic neoplasms and, to a lesser extent, breast cancer. Increasingly, systemic chemotherapy is recognized as efficacious in the treatment of leptomeningeal metastasis in part because it has the ability to penetrate into bulky disease seen on neuroimaging. The optimum choice of therapy depends upon a thorough assessment of the neurologic extent of disease, which should include complete neuraxis imaging. Patients with extensive bulky disease may be best treated with systemic chemotherapy, whereas those with a positive CSF cytology but negative imaging may be treated with intrathecal chemotherapy and spared the systemic toxicity of intravenous drug. Despite vigorous therapy, many patients do poorly and the median survival is only about four months. Nevertheless, some patients, particularly those with leukemia, lymphoma, and breast cancer, respond and a substantial minority will be alive one to two years after diagnosis. Copyright © Taylor & Francis Inc. |
| Keywords: | cancer survival; survival analysis; leukemia; cancer surgery; clinical feature; clinical trial; drug tolerability; drug efficacy; side effect; cancer radiotherapy; chemotherapy; cytarabine; methotrexate; neuroimaging; neurotoxicity; nuclear magnetic resonance imaging; magnetic resonance imaging; cytology; metastasis; breast cancer; bone marrow suppression; diagnosis, differential; bleeding; mucosa inflammation; nausea; antineoplastic combined chemotherapy protocols; radiotherapy; dexamethasone; breast neoplasms; thiotepa; drug fever; chemotherapy induced emesis; cerebrospinal fluid; lumbar puncture; meningeal neoplasms; early diagnosis; laboratory test; folinic acid; nerve fiber; lymphoma; dementia; headache; corticosteroid; cerebrospinal fluid analysis; drug dose regimen; ataxia; treatment withdrawal; cranial nerve; hematopoietic system tumor; drug choice; cerebrospinal fluid flow; leptomeningeal metastasis; radiculopathy; arachnoiditis; intrathecal chemotherapy |
| Journal Title: | Cancer Investigation |
| Volume: | 23 |
| Issue: | 2 |
| ISSN: | 0735-7907 |
| Publisher: | Informa Healthcare |
| Date Published: | 2005-01-01 |
| Start Page: | 145 |
| End Page: | 154 |
| Language: | English |
| DOI: | 10.1081/cnv-200050458 |
| PUBMED: | 15813508 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 41" - "Export Date: 24 October 2012" - "CODEN: CINVD" - "Source: Scopus" |
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