Leptomeningeal cancer

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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.<ref>,

 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,</ref>

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.<ref>,

 Handbook of Neuro-Oncology Neuroimaging, 
  
 Elsevier, 
 2016, 
  
  
 ISBN 978-0-12-800945-1,</ref>

Meningeosis carcinomatosa bei Mammakarzinom 40W - MR - 001

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.<ref>,

 Leptomeningeal metastases: a RANO proposal for response criteria, 
 Neuro-Oncology, 
 2017,
 Vol. 19(Issue: 4),
 pp. 484-492,
 DOI: 10.1093/neuonc/now183,</ref>

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.<ref>,

 Leptomeningeal Carcinomatosis, 
 Clinical Oncology, 
 2019,
 Vol. 31(Issue: 10),
 pp. 708-715,
 DOI: 10.1016/j.clon.2019.07.001,</ref>

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.<ref>,

 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,</ref>

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.<ref>,

 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,</ref>

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.<ref>,

 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,</ref>

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.<ref>,

 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,</ref>

See also

• Meninges
• Neoplasia
• Metastasis

References

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