Newer Avenues for the Treatment of Leptomeningeal Carcinomatosis

Fausto      Meriggi; Alberto      Zaniboni

doi:10.2174/187152411794961068

Abstract

Leptomeningeal Carcinomatosis (LC) refers to diffuse seeding of the leptomeninges by tumor metastases and is a rare presentation of solid tumors, particularly breast cancer, lung cancer and malignant melanoma in adults and hematogenous malignancies and primitive neuroectodermal tumor (PNET) in children. Recently, the incidence of LC has been reported to be increasing due to a longer overall survival obtained in patients treated with novel antineoplastic agents. The usual clinical presentation is a multifocal involvement of the neuraxis, with headache and radicular pain being the most common initial symptoms. The most frequent signs are motor deficits, altered mental status and cranial nerve involvement. The treatment of LC remains controversial and no straightforward guidelines exist in the literature. It has a bad prognosis and inevitably fatal outcome despite aggressive therapy.

Keywords: Leptomeningeal carcinomatosis, systemic therapy, intrathecal therapy, chemotherapy, radioterapy, methotrexate, capecitabine, temozolamide, ccnu, bcnu, thiotepa, ara-c, lung cancer, breast cancer, erlotinib, gefitinib, Ommaya, liposomal cytarabine, mafosfamide, topotecan, bevacizumab, medulloblastoma, DepoCyt, MRI, leukemia, CSF cytology