Leptomeningeal Metastasis: Challenges in Diagnosis and Treatment

University of Wisconsin Paul P Carbone Comprehensive Cancer Center 600 Highland Ave Madison WI, 537192.
Current Cancer Therapy Reviews 11/2011; 7(4):319-327. DOI: 10.2174/157339411797642597
Source: PubMed


As therapeutic options and supportive care for the treatment of neoplastic disease have improved, there has been an associated increase in the incidence of leptomeningeal disease. In this review, the clinical presentation, natural history, diagnostic evaluation, and treatment options for this often devastating sequela of solid tumors, lymphoma, and leukemia will be summarized. The therapeutic efficacy of ionizing radiation, systemic agents, and intrathecal drugs will be examined from the existing literature. Additionally the pathophysiology, which in part defines the therapeutic limitations in approaching this patient population, will be discussed in order to assist in individualized clinical decision making.

Download full-text


Available from: Minesh P Mehta, Feb 18, 2015
  • Source
    • "The goal of leptomeningeal metastasis-directed treatment is to stabilize the neurological status, improve quality of life, and prolong survival. Systemic and intra-CSF chemotherapy and site-specific radiotherapy are common treatment approaches [16]. In this report, the patient received concurrent radiotherapy and chemotherapy and achieved good effect without severe side effects. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma. Case presentation We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy. Conclusion To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.
    BMC Cancer 06/2014; 14(1):399. DOI:10.1186/1471-2407-14-399 · 3.36 Impact Factor

  • Gastrointestinal cancer research: GCR 05/2013; 6(3):90-2.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To assess the results of the treatment of patients with breast cancer leptomeningeal metastasis (LM) and to compare the efficacy of methotrexate and liposomal cytarabine in patients treated intrathecally by lumbar puncture. Patients and methods In this prospective observational study 149 consecutive patients with breast cancer and LM treated between the years 1999 and 2011 were assessed. Multimodality treatment methods were used: systemic therapy in 77 patients, radiation therapy in 92 patients, intrathecal methotrexate in 81 patients and intrathecal liposomal cytarabine in 15 patients. Results Median survival of all patients was 4.2 months. Median survival of patients in whom systemic intravenous/oral treatment was used was 6 months and in those without systemic treatment was 2 months (p <0.001). Median survival of patients treated with intrathecal methotrexate was 4.2 months, those treated with intrathecal liposomal cytarabine was 4.6 months and without intrathecal treatment was 3.7 months (p=0.717). Median survival after whole-brain radiation therapy was 4.6 months and without irradiation was 3.2 months (p=0.028). Multivariate analysis revealed that Karnofsky Performance Status of >70, systemic intravenous/oral treatment and bones as a site of metastases were factors prolonging survival from LM. Conclusion Among treatment methods, only systemic therapy prolonged survival in patients with LM. Nor radiation therapy neither lumbar intrathecal therapy influenced survival in those patients however both methods alleviated signs and symptoms of LM. No difference in survival was observed in patients treated intrathecally with methotrexate and those treated with liposomal cytarabine. Treatment with both drugs was comparable.
    Clinical Breast Cancer 08/2014; 15(1). DOI:10.1016/j.clbc.2014.07.004 · 2.11 Impact Factor
Show more