Neoplastic meningitis.
BACKGROUND
Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer.


RESULTS
Notwithstanding frequent focal signs and symptoms in NM, NM is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments.


RESULTS
Central nervous system (CNS) staging of NM includes contrast-enhanced cranial computed tomography (CE-CT) or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging (MR-S) or computed tomographic myelography (CT-M), and radionuclide CSF flow study (FS). Treatment of NM incorporates 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 3 chemotherapeutic agents (ie, methotrexate, cytosine arabinoside, and thio-TEPA) administered by a variety of schedules either by intralumbar or intraventricular drug delivery.


CONCLUSIONS
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.
Chamberlain
Marc C
MC
Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of Southern Florida, Neuro-Oncology Program, Tampa, Florida 33612, USA. chambemc@moffitt.usf.edu
D006801:Humans; D008577:Meningeal Neoplasms / Q000150:complications* / Q000556:secondary / Q000628:therapy*; D008581:Meningitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*