title: Neoplastic meningitis from solid tumors: new diagnostic and therapeutic approaches.
abstract: Neoplastic meningitis is a result of the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid. This event occurs in 4%-15% of all patients with solid tumors and represents an important prognostic factor for poor survival. Neoplastic meningitis should be diagnosed in the early stages of disease to prevent important neurological deficits and to provide the most appropriate treatment. Despite new diagnostic approaches developed in recent years, such as positron emission tomography-computed tomography and new biological markers, the combination of magnetic resonance imaging without and with gadolinium enhancement and cytology still has the greatest diagnostic sensitivity. Recently, no new randomized studies comparing intrathecal (i.t.) with systemic treatment have been performed, yet there have been a few small phase II studies and case reports about new molecularly targeted substances whose successful i.t. or systemic application has been reported. Trastuzumab, gefitinib, and sorafenib are examples of possible future treatments for neoplastic meningitis, in order to better individualize therapy thus allowing better outcomes. In this review, we analyze the most recent and interesting developments on diagnostic and therapeutic approaches.
authors.affiliation: Medical Oncology 1 Unit, Istituto Oncologico Veneto–IRCCS, Padova, Italy. giuseppe.lombardi@ioveneto.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.forename: Fable
authors.initials: F
authors.lastname: Zustovich
authors.forename: Patrizia
authors.initials: P
authors.lastname: Farina
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.forename: Renzo
authors.initials: R
authors.lastname: Manara
authors.forename: Diego
authors.initials: D
authors.lastname: Cecchin
authors.forename: Antonella
authors.initials: A
authors.lastname: Brunello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappetta
authors.forename: Vittorina
authors.initials: V
authors.lastname: Zagonel
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006801:Humans; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000532:radiotherapy; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000134:cerebrospinal fluid / Q000150:complications*; D013346:Subarachnoid Space / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents