Current opinion in oncology · 2010
Leptomeningeal metastasis.
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Chamberlain Marc C
Аннотация
PURPOSE OF REVIEW: Leptomeningeal metastasis occurs in approximately 3-5% of all patients with cancer. A contemporary literature review of methods of diagnosis and treatment of leptomeningeal metastasis was performed.
RECENT FINDINGS: The single most important aspect to diagnosis of leptomeningeal metastasis is considering and pursuing the diagnosis in a patient with cancer and neurological signs and symptoms. Evaluation of leptomeningeal metastasis includes contrast-enhanced brain and spine magnetic resonance imaging (MRI) and a radionuclide cerebrospinal fluid (CSF) flow study if leptomeningeal metastasis-directed therapy is being considered. Treatment often requires involved-field radiotherapy to bulky or symptomatic disease sites as well as intra-CSF and systemic chemotherapy. The use of high-dose systemic therapy may benefit patients with leptomeningeal metastasis and obviate the need for intra-CSF chemotherapy. Intra-CSF drug therapy primarily utilizes one of three chemotherapeutic agents (i.e. methotrexate, cytosine arabinoside and thio-TEPA) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Novel and increasingly utilized intra-CSF agents in the treatment of leptomeningeal metastasis are targeted monoclonal antibodies such as rituximab and trastuzumab.
SUMMARY: Although treatment of leptomeningeal metastasis is palliative with median patient survival of 2-3 months (15% of patients with leptomeningeal metastasis survive 1 year), treatment may afford stabilization and protection from further neurologic deterioration in patients with leptomeningeal metastasis.
RECENT FINDINGS: The single most important aspect to diagnosis of leptomeningeal metastasis is considering and pursuing the diagnosis in a patient with cancer and neurological signs and symptoms. Evaluation of leptomeningeal metastasis includes contrast-enhanced brain and spine magnetic resonance imaging (MRI) and a radionuclide cerebrospinal fluid (CSF) flow study if leptomeningeal metastasis-directed therapy is being considered. Treatment often requires involved-field radiotherapy to bulky or symptomatic disease sites as well as intra-CSF and systemic chemotherapy. The use of high-dose systemic therapy may benefit patients with leptomeningeal metastasis and obviate the need for intra-CSF chemotherapy. Intra-CSF drug therapy primarily utilizes one of three chemotherapeutic agents (i.e. methotrexate, cytosine arabinoside and thio-TEPA) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Novel and increasingly utilized intra-CSF agents in the treatment of leptomeningeal metastasis are targeted monoclonal antibodies such as rituximab and trastuzumab.
SUMMARY: Although treatment of leptomeningeal metastasis is palliative with median patient survival of 2-3 months (15% of patients with leptomeningeal metastasis survive 1 year), treatment may afford stabilization and protection from further neurologic deterioration in patients with leptomeningeal metastasis.