title: Management of neoplastic meningitis.
abstract: Leptomeningeal dissemination of tumor cells, also referred to as neoplastic meningitis, is most frequently seen in patients with late-stage cancer and mostly associated with a poor prognosis. Basically, neoplastic meningitis may affect all patients with a malignant tumor but is most common in patients affected by lung cancer, breast carcinoma, melanoma or hematologic neoplasms such as lymphoma and leukemia. Controlled clinical trials are largely lacking which results in various non-standardized treatment regimens. The presence of solid tumor manifestations in the CNS as well as the extracranial tumor load defines the most appropriate treatment approach. Radiation therapy, systemic chemotherapy and intrathecal treatment must be considered. For each patient, the individual situation needs to be carefully evaluated to determine the potential benefit as well as putative side effects associated with any therapy. A moderate survival benefit and particularly relief from pain and neurological deficits are the main treatment goals. Here, we summarize the management of patients with neoplastic meningitis and review the available treatment options.
authors.affiliation: Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland. patrick.roth@usz.ch.
authors.forename: Patrick
authors.initials: P
authors.lastname: Roth
authors.affiliation: Department of Neurology, Brain Tumor Center Zurich, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Weller
mesh_terms: D000818:Animals; D003131:Combined Modality Therapy; D006801:Humans; D055756:Meningeal Carcinomatosis / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008581:Meningitis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D059906:Neuroimaging / Q000379:methods; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Neoplastic meningitis; intrathecal therapy; leptomeningeal carcinomatosis; tumor cell dissemination