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Semin Neurol 2023; 43(06): 859-866
DOI: 10.1055/s-0043-1776996
Review Article

Leptomeningeal Carcinomatosis from Solid Tumor Malignancies: Treatment Strategies and Biomarkers

Rachna Malani
1   Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
,
Ankush Bhatia
2   Department of Neurology, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
,
Allison Betof Warner
3   Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
,
Jonathan T. Yang
4   Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
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Abstract

Leptomeningeal metastases/diseases (LMDs) are a late-stage complication of solid tumor or hematologic malignancies. LMD is spread of cancer cells to the layers of the leptomeninges (pia and arachnoid maters) and subarachnoid space seen in 3 to 5% of cancer patients. It is a disseminated disease which carries with it significant neurologic morbidity and mortality. Our understanding of disease pathophysiology is currently lacking; however, advances are being made. As our knowledge of disease pathogenesis has improved, treatment strategies have evolved. Mainstays of treatment such as radiotherapy have changed from involved-field radiotherapy strategies to proton craniospinal irradiation which has demonstrated promising results in recent clinical trials. Systemic treatment strategies have also improved from more traditional chemotherapeutics with limited central nervous system (CNS) penetration to more targeted therapies with better CNS tumor response. Many challenges remain from earlier clinical detection of disease through improvement of active treatment options, but we are getting closer to meaningful treatment.

Keywords

Leptomeningeal disease - Lepotomeningeal carcinomatosis - central nervous system - cerebrospinal fluid


Publication History

Article published online:
21 November 2023

© 2023. Thieme. All rights reserved.

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