title: Neoplastic meningitis from solid tumors: a prospective clinical study in lombardia and a literature review on therapeutic approaches.
abstract: Neoplastic dissemination to the leptomeninges is an increasingly common occurrence in patients with both haematological and solid tumors arising outside the central nervous system. Both refinement of diagnostic techniques (Magnetic resonance imaging) and increased survival in patients treated with targeted therapies for systemic tumors account for this increased frequency. Cerebrospinal fluid cytological analysis and MRI confirm clinical diagnosis based on multifocal central nervous system signs/symptoms in a patient with known malignancy. Overall survival in patients with leptomeningeal neoplastic dissemination from solid tumors is short, rarely exceeding 3-4 months. However, selected patients may benefit from aggressive therapies, Apart from symptomatic treatment, intrathecal chemotherapy is used, with both free (methotrexate, Thiotepa, AraC) and liposomal antitumor agents (liposomal AraC). Palliative radiotherapy is indicated only in cases of symptomatic bulky disease, surgery is limited to positioning of Ommaya recervoirs or C5F shunting. We report clinical data on a cohort of 26 prospectively followed patients with neoplastic leptomeningitis followed in Lombardia, Italy, in 2011. Prognostic factors and pattern of care are reported.
authors: Fondazione I.R.C.C.S. Istituto Neurologico C. Besta, Milano, Italy.
authors: A
authors: A
authors: Silvani
authors: M
authors: M
authors: Caroli
authors: P
authors: P
authors: Gaviani
authors: V
authors: V
authors: Fetoni
authors: R
authors: R
authors: Merli
authors: M
authors: M
authors: Riva
authors: M
authors: M
authors: De Rossi
authors: F
authors: F
authors: Imbesi
authors: A
authors: A
authors: Salmaggi
references: J Clin Oncol. 1999 Oct;17(10):3110-6
references: 10506606
references: J Clin Oncol. 2009 Mar 20;27(9):1462-9
references: 19224854
references: J Neurooncol. 1998 Jun-Jul;38(2-3):245-52
references: 9696379
references: J Neurooncol. 2012 Jan;106(2):225-34
references: 21874597
references: J Clin Oncol. 2007 May 1;25(13):e14-6
references: 17470852
references: Cancer. 1982 Feb 15;49(4):759-72
references: 6895713
references: Eur J Cancer. 2004 Dec;40(18):2726-33
references: 15571954
references: Curr Oncol Rep. 2010 Jan;12(1):41-9
references: 20425607
references: Clin Pharmacol Ther. 1984 Jun;35(6):826-30
references: 6587957
references: Neurol Clin. 2003 Feb;21(1):25-66
references: 12690644
references: Leuk Lymphoma. 2007 Sep;48(9):1849-51
references: 17786723
references: Oncologist. 2011;16(8):1175-88
references: 21795431
references: Neuro Oncol. 2001 Jan;3(1):42-5
references: 11305416
references: Ann Pharmacother. 2000 Oct;34(10):1173-8
references: 11054987
references: J Neurooncol. 2009 Feb;91(3):271-7
references: 18820836
references: Blood. 2007 Apr 15;109(8):3214-8
references: 17209054
references: Blood. 2005 Jan 15;105(2):496-502
references: 15358629
references: Lancet Neurol. 2006 May;5(5):443-52
references: 16632315
references: Curr Opin Oncol. 2010 Nov;22(6):627-35
references: 20689429
references: Clin Cancer Res. 1999 Nov;5(11):3394-402
references: 10589750
references: Cancer. 1994 Dec 1;74(11):3034-41
references: 7954266