Leptomeningeal cancer
Editor-In-Chief: Prab R Tumpati, MD
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| Leptomeningeal cancer | |
|---|---|
| |
| Synonyms | Leptomeningeal carcinomatosis, neoplastic meningitis |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Headache, nausea, vomiting, seizures, cranial nerve deficits |
| Complications | Hydrocephalus, neurological deficits |
| Onset | Variable, often subacute |
| Duration | Progressive |
| Types | N/A |
| Causes | Metastasis from breast cancer, lung cancer, melanoma, others |
| Risks | Advanced cancer, certain tumor types |
| Diagnosis | Lumbar puncture, MRI |
| Differential diagnosis | Meningitis, multiple sclerosis, stroke |
| Prevention | N/A |
| Treatment | Radiation therapy, chemotherapy, intrathecal therapy |
| Medication | N/A |
| Prognosis | Poor, median survival 2-4 months |
| Frequency | Occurs in 5-8% of patients with cancer |
| Deaths | N/A |
Leptomeningeal cancer, also known as leptomeningeal disease (LMD) or neoplastic meningitis, refers to a rare complication of cancer in which the disease spreads to the membranes (meninges) surrounding the brain and spinal cord.[1]
Clinical Presentation
Patients with leptomeningeal cancer may present with a range of neurologic symptoms, which can include headaches, nausea, vomiting, changes in behavior, seizures, weakness or numbness in the limbs, problems with balance or coordination, and difficulty with speech or swallowing.[2]
Pathogenesis
The cancer spreads to the leptomeninges through the blood or lymphatic system, or by direct extension from pre-existing lesions. The most common cancers that lead to leptomeningeal disease are breast cancer, lung cancer, and melanoma, as well as certain types of brain tumors.[3]
Diagnosis
Diagnosis is based on clinical symptoms, imaging studies, and cerebrospinal fluid (CSF) analysis. Magnetic resonance imaging (MRI) is typically used to identify any abnormalities in the brain or spinal cord. A lumbar puncture is performed to collect a sample of CSF, which is then examined for cancer cells.[4]
Treatment
The treatment of leptomeningeal cancer is challenging and primarily aimed at controlling symptoms and improving quality of life. Therapeutic options may include systemic chemotherapy, targeted therapy, radiation therapy, or intrathecal chemotherapy, in which drugs are injected directly into the CSF. The specific treatment plan will depend on the type of primary cancer, the extent of disease, and the patient's overall health.[5]
Prognosis
The prognosis for leptomeningeal cancer is generally poor, with a median survival of a few months. However, with optimal treatment and management, some patients may live longer.[6]
Epidemiology
The incidence of leptomeningeal disease is increasing, which is thought to be due to improved cancer treatments leading to longer survival times, as well as improved diagnostic methods.[7]
Future Directions
Research is ongoing to develop new treatments for leptomeningeal disease, including more effective chemotherapeutic agents, targeted therapies, and immunotherapies. Further study is also needed to better understand the biology of this disease and to identify potential biomarkers for early detection and monitoring of treatment response.[8]
See also
References
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 |
 |
- ↑ , The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal, Neuro-Oncology, 2020, Vol. 22(Issue: 5), pp. 689-693, DOI: 10.1093/neuonc/noaa021,
- ↑ , Handbook of Neuro-Oncology Neuroimaging, Elsevier, 2016, ISBN 978-0-12-800945-1,
- ↑ , Leptomeningeal metastases: a RANO proposal for response criteria, Neuro-Oncology, 2017, Vol. 19(Issue: 4), pp. 484-492, DOI: 10.1093/neuonc/now183,
- ↑ , Leptomeningeal Carcinomatosis, Clinical Oncology, 2019, Vol. 31(Issue: 10), pp. 708-715, DOI: 10.1016/j.clon.2019.07.001,
- ↑ , Current treatment options for leptomeningeal disease, Current Treatment Options in Oncology, 2020, Vol. 21(Issue: 1), pp. 7, DOI: 10.1007/s11864-019-0703-1,
- ↑ , Leptomeningeal metastases current challenges and future directions, Journal of Clinical Oncology, 2020, Vol. 38(Issue: 24), pp. 2746-2753, DOI: 10.1200/JCO.19.03148,
- ↑ , Symptom burden in patients with leptomeningeal metastases: a prospective study, Supportive Care in Cancer, 2020, Vol. 28(Issue: 10), pp. 4873-4881, DOI: 10.1007/s00520-020-05420-z,
- ↑ , A phase II trial of pembrolizumab for untreated leptomeningeal metastases from non-small cell lung cancer, Clinical Cancer Research, 2021, DOI: 10.1158/1078-0432.CCR-21-0045,
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Contributors: Prab R. Tumpati, MD
