How we treat patients with leptomeningeal metastases

Abstract

The goal of treatment of leptomeningeal metastasis is to improve survival and to maintain quality of life by delaying neurological deterioration. Tumour-specific therapeutic options include intrathecal pharmacotherapy, systemic pharmacotherapy and focal radiotherapy. Recently, improvement of leptomeningeal disease–related progression-free survival by adding intrathecal liposomal cytarabine to systemic treatment versus systemic treatment alone has been observed in a randomised phase III trial for patients with breast cancer with newly diagnosed leptomeningeal metastasis. Safety and efficacy of intrathecal administration of new agents such as trastuzumab are under evaluation. Systemic therapy using targeted agents and immunotherapy has also improved outcome in patients with brain metastasis, and its emerging role in the management of leptomeningeal metastasis needs to better studied in prospective series. Focal radiotherapy is commonly indicated for the treatment of macroscopic disease such as meningeal nodules or clinically symptomatic central nervous system structures, for example, base of skull with cranial nerve involvement or cauda equine syndrome. The role of whole brain radiotherapy is decreasing. An individualised combination of different therapeutic options should be used considering the presentation of leptomeningeal metastasis, as well as the histological and molecular tumour characteristics, the presence of concomitant brain and systemic metastases, and prior cancer-directed treatments.

Leptomeningeal Disease as a Rare Complication of Primary Penile Urethral Cancer

“…This may also underlie the observation that LMD risk rises with longer cancer survival, which will likely occur with further improvement in cancer therapeutics [7]. LMD carries a very poor prognosis, and studies in the most common cancer types demonstrate overall survival of less than 6 months [8]. Intrathecal chemotherapy remains the mainstay of treatment.…”

Palliative approach to leptomeningeal carcinomatosis in oesophagogastric junction cancer

“…CT scans rarely show abnormal findings, while MRI sensitivity is around 65%–75% 9 13. LC diagnosis is probable with typical clinical and imaging signs, independently of the presence of tumour cells in CSF 5 14. MRI also has a role in the classification of LC which guides clinical decision-making 14…”

“…PS at diagnosis of LC is the most important prognostic factor 5. While patients with good PS can endure aggressive treatments, including ChT, only 27% of patients with ECOG PS3–4 or Karnofsky score below 60% receive IT ChT and these present a survival around 2 months 7 14–16. Besides minor survival benefit, treatment also implies economic costs, invasive procedures and frequent admissions.…”

“…Moreover, prolonged survival with treatment in LC is usually achieved in breast and lung cancer, while other solid cancers show very poor prognosis 5 7. Other poor prognostic factors include age over 50 years, major neurological deficits, high burden central nervous system (CNS) disease and high protein level in CSF 6 14 15. Guidelines propose BSC in these patients, except for chemosensitive tumours, such as lymphoma or specific cases where RT may help symptom control 15…”

Leptomeningeal canceromatosis in patient with parameningeal rhabdomyosarcoma

“…За исключением высокочувствительных к противоопухолевой терапии заболеваний (острый лимфобластный лейкоз, некоторые лимфомы), лечение лептоменингеальных метастазов в основном паллиативное. С целью сдерживания и временной стабилизации процесса применяют интратекальное и системное введение химиопрепаратов, лучевую терапию [12][13][14]21]. В нашем наблюдении у пациента № 1 из-за неправильной трактовки процесса противоопухолевую терапию, направленную на лечение ЛМК, не проводили, так как предполагалось, что проявления обусловлены инфекционным поражением оболочек.…”