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Semin Neurol 2004; 24(4): 363-374
DOI: 10.1055/s-2004-861531
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Neoplastic Meningitis

Marc C. Chamberlain1
  • 1Professor of Neurology and Neurosurgery, Department of Neurology and Neurological Surgery, University of Southern California, Keck School of Medicine, Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
Further Information

Publication History

Publication Date:
07 January 2005 (online)

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ABSTRACT

Neoplastic meningitis is a common problem in neuro-oncology, occurring in ∼5% of all patients with cancer. Notwithstanding frequent focal signs and symptoms, neoplastic meningitis is a disease affecting the entire neuraxis; therefore, staging and treatment must encompass all cerebrospinal fluid (CSF) compartments. Central nervous system staging of neoplastic meningitis includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging, contrast-enhanced spine magnetic resonance imaging, or computerized tomographic myelography and radionuclide CSF flow study (FS). Treatment of neoplastic meningitis includes involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with neoplastic meningitis and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (i.e., methotrexate, cytosine arabinoside, and thio-triethylenephosphoramide) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of neoplastic meningitis is palliative with an expected median patient survival of 2 to 6 months, it often affords stabilization and protection from further neurological deterioration.

KEYWORDS

Neoplastic meningitis - leptomeningeal metastases

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Marc C ChamberlainM.D. 

Department of Neurology and Neurological Surgery, University of Southern California, Keck School of Medicine, Norris Comprehensive Cancer Center and Hospital

1441 Eastlake Avenue, Room 3459

Los Angeles, CA 90033-0804