Leptomeningeal neoplasms |
| |
Authors: | Jan Drappatz Tracy T Batchelor |
| |
Institution: | (1) Harvard Medical School, Department of Neurology, Brigham and Women’s Hospital and Dana-Farber/Brigham and Women’s Cancer Center, Center for Neuro-Oncology, 44 Binney Street SW 430, Boston, MA 02115, USA |
| |
Abstract: | Opinion statement Leptomeningeal metastasis is becoming an increasingly important late complication of cancer as survival from systemic disease
increases, and due to the fact that many novel cancer drugs fail to achieve therapeutic concentrations in the central nervous
system. It occurs when neoplastic cells enter cerebrospinal fluid (CSF) pathways, causing diffuse infiltration of the subarachnoid
space of the brain and spinal cord. Definitive diagnosis is established by the demonstration of malignant cells in the CSF.
However, in certain circumstances the presence of leptomeningeal enhancement on brain or spinal MRI may be sufficient to make
the diagnosis. Early diagnosis and aggressive treatment may delay neurologic progression and can lead to prolonged survival
and improvement of neurologic function in certain patients. The prognosis depends on the underlying malignancy but is often
poor, with a median survival of 4 months, and most treatment interventions are palliative. Nevertheless, some patients respond
to treatment, and some survive beyond 1 or 2 years after diagnosis. Areas of radiographic bulky disease or symptomatic tumor
should receive radiotherapy. Intrathecal chemotherapy is most effective in patients with lymphoma, leukemia, or breast cancer
and without evidence of bulky disease on neuroimaging. Intrathecal chemotherapy requires normal CSF flow, and the most commonly
used agents are methotrexate, cytarabine, and thiotepa. In lieu of intrathecal therapy, systemic chemotherapy may occasionally
be indicated in select patients in part based on its ability to penetrate into bulky disease. When hydrocephalus occurs, ventriculoperitoneal
shunting frequently leads to rapid clinical improvement. There is hope that progress in diagnostic modalities and the development
of more effective intrathecal antineoplastic drugs may decrease neurologic morbidity and improve quality of life and survival. |
| |
Keywords: | |
本文献已被 PubMed SpringerLink 等数据库收录! |
|