title: Neoplastic meningitis.
abstract: Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer. Notwithstanding frequent focal signs and symptoms, NM is a disease that affects the entire neuraxis; therefore, staging and treatment need to encompass all cerebrospinal fluid (CSF) compartments. Central nervous system (CNS) staging of NM includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging, contrast-enhanced spine magnetic resonance imaging or computerized tomographic myelography, and radionuclide CSF flow study. Treatment of NM involves involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with NM and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (ie, methotrexate, cytosine arabinoside, and thio-triethylene thiophosphoramide) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of NM is palliative with an expected median patient survival of 2 to 6 months, it often affords stabilization and protection from further neurologic deterioration in patients with NM.
authors.affiliation: Department of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Center and Hospital, 1441 Eastlake Avenue, Room 3459, Los Angeles, CA 90033-0804, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Aparicio
authors.forename: Marc C
authors.initials: MC
authors.lastname: Chamberlain
mesh_terms: D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008578:Meninges / Q000473:pathology* / Q000503:physiopathology; D008581:Meningitis / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D009362:Neoplasm Metastasis / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D009367:Neoplasm Staging