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
REFERENCES
In situ hybridization: a possible diagnostic aid in leptomeningeal metastasis.
J Neurooncol.
1998;
38
127-133
131 I-radiolabelled monoclonal antibodies.
J Neurooncol.
1998;
38
225-232
