Neoplastic Meningitis Due to Lung, Breast, and Melanoma Metastases.
BACKGROUND
Neoplastic meningitis, a central nervous system (CNS) complication of cancer metastatic to the meninges and cerebrospinal fluid (CSF), is relevant to oncologists due to the impact of the disease on patient quality of life and survival rates.


METHODS
A review of the literature of articles published in English was conducted with regard to neoplastic meningitis.


RESULTS
The incidence of neoplastic meningitis is increasing because patients with cancer are surviving longer in part because of the use of novel therapies with poor CNS penetration. Up to 5% of patients with solid tumors develop neoplastic meningitis during the disease course (breast cancer, lung cancer, and melanoma being the predominantly causative cancers). The rate of median survival in patients with untreated neoplastic meningitis is 1 to 2 months, although it can be as long as 5 months in some cases. Therapeutic options for the treatment of neoplastic meningitis include systemic therapy (cancer-specific, CNS-penetrating chemotherapy or targeted therapies), intra-CSF administration of chemotherapy (methotrexate, cytarabine, thiotepa) and CNS site-specific radiotherapy. Determining whom to treat with neoplastic meningitis remains challenging and, in part, relates to the extent of systemic disease, the neurological burden of disease, the available systemic therapies, and estimated rates of survival.


CONCLUSIONS
The prognosis of neoplastic meningitis remains poor. The increasing use of novel, targeted therapies and immunotherapy in solid tumors and its impact on neoplastic meningitis remains to be determined and is an area of active research. Thus, well conducted trials are needed.
Division of Neuro-Oncology in the Department of Neurosurgery, University Hospital and the Breast Unit in the Department of Medical Oncology, Oscar Lambret Center, Lille Cedex, France.
Emilie
E
Le Rhun
Division of Neuro-Oncology in the Departments of Neurology, and Radiation Oncology, Pitie-Salpetriere Hospital, and Assistance Publique des Hopitaux de Paris, Universite Pierre et Marie Curie, Paris, France.
Sophie
S
Taillibert
Department of Neurology, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, and Division of Neuro-Oncology, Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA. marccchamberlain@gmail.com.
Marc C
MC
Chamberlain
D001943:Breast Neoplasms / Q000150:complications* / Q000556:secondary; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000556:secondary; D008545:Melanoma / Q000150:complications* / Q000556:secondary; D008581:Meningitis / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate