Neoplastic meningitis.
Neoplastic meningitis is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer. Notwithstanding frequent focal signs and symptoms, neoplastic meningitis is a disease affecting the entire neuraxis; therefore, staging and treatment must encompass all cerebrospinal fluid (CSF) compartments. Central nervous system staging of neoplastic meningitis 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 (FS). Treatment of neoplastic meningitis includes involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with neoplastic meningitis and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (i.e., methotrexate, cytosine arabinoside, and thio-triethylenephosphoramide) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of neoplastic meningitis is palliative with an expected median patient survival of 2 to 6 months, it often affords stabilization and protection from further neurological deterioration.
Chamberlain
Marc C
MC
Department of Neurology and Neurological Surgery, University of Southern California, Keck School of Medicine, Norris Comprehensive Cancer Center and Hospital, 1441 Eastlake Avenue, Room 3459, Los Angeles, CA 90033-0804, USA.
D000971:Antineoplastic Combined Chemotherapy Protocols; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D008577:Meningeal Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D011878:Radiotherapy