Skip to main content

Advertisement

SpringerLink
Log in

Leptomeningeal neoplasms

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Leptomeningeal metastases are a late, devastating complication of systemic cancer that typically occurs in conjunction with other systemic relapse. The most common neurologic symptoms include headache, altered mentation, and difficult walking. Diagnosis is established by neuroimaging and cerebrospinal fluid analysis. The prognosis is poor with a median survival of 6 to 8 weeks; therefore most treatment interventions are palliative. Radiotherapy should be given to sites of bulky or symptomatic tumor. Intrathecal chemotherapy is most effective in patients with lymphoma, leukemia, and breast cancer. Systemic chemotherapy may be more effective in treating bulky leptomeningeal tumor. Ventriculoperitoneal shunting can be extremely useful in patients with obstructive hydrocephalus or increased intracranial pressure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Eberth CJ: Zur entwickelung des epitheliomas (cholesteatomas) der pia und der lung. Virchows Arch 1870, 49:51–63.

    Google Scholar 

  2. Siefert E: Uber die multiple Karzinomatose des Zentralnervensystems. Munch Med Wochenschr 1902, 49:826–828.

    Google Scholar 

  3. DeAngelis LM: Current diagnosis and treatment of leptomeningeal metastasis. J Neurooncol 1998, 38:245–252.

    Article  PubMed  CAS  Google Scholar 

  4. Olson MD, Chernik NL, Posner JB: Infiltration of the leptomeninges by systemic cancer: a clinical and pathologic study. Arch Neurol 1974, 30:122–137.

    PubMed  CAS  Google Scholar 

  5. Wasserstrom W, Glass JP, Posner JB: Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 1982, 49:759–772.

    Article  PubMed  CAS  Google Scholar 

  6. Freilich RJ, Krol G, DeAngelis LM: Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastases. Ann Neurol 1995, 38:51–57.

    Article  PubMed  CAS  Google Scholar 

  7. Schumacher M, Orszagh M: Imaging techniques in neoplastic meningiosis. J Neurooncol 1998, 38:111–120.

    Article  PubMed  CAS  Google Scholar 

  8. Boogerd W, Hart AAM, van derSande JJ, Engelsman E: Meningeal carcinomatosis in breast cancer: prognostic factors and influence of treatment. Cancer 1991, 67:1685–1695.

    Article  PubMed  CAS  Google Scholar 

  9. Schrappe M, Reiter A, Riehm H: Prophylaxis and treatment of neoplastic meningiosis in childhood acute lymphoblastic leukemia. J Neurooncol 1998, 38:159–165.

    Article  PubMed  CAS  Google Scholar 

  10. Siegal T, Lossos A, Pfeffer MR: Leptomeningeal metastases: analysis of 31 patients with sustained off-therapy response following combined-modality therapy. Neurology 1994, 44:1463–1469.

    PubMed  CAS  Google Scholar 

  11. Glantz MJ, Cole BF, Recht L, et al.: High-dose intravenous methotrexate for patients with nonleukemic leptomeningeal cancer: is intrathecal chemotherapy necessary? J Clin Oncol 1998, 16:1561–1567. Systemic methotrexate achieves therapeutic CSF levels and possibly superior results when compared with intrathecal chemotherapy.

    PubMed  CAS  Google Scholar 

  12. Siegal T: Leptomeningeal metastases: rationale for systemic chemotherapy or what is the role of intra-CSF chemotherapy? J Neurooncol 1998, 38:151–157.

    Article  PubMed  CAS  Google Scholar 

  13. Tetef ML, Margolin KA, Doroshow JH, et al.: Pharmacokinetics and toxicity of high-dose intravenous methotrexate in the treatment of leptomeningeal carcinomatosis. Cancer Chemother Pharmacol 2000, 46:19–26.

    Article  PubMed  CAS  Google Scholar 

  14. Shapiro WR, Young DF, Mehta BM: Methotrexate: distribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. N Engl J Med 1975, 293:161–166.

    Article  PubMed  CAS  Google Scholar 

  15. Chamberlain MC, Kormanick PA: Neoplastic meningitis: a guide to diagnosis and treatment. CNS Drugs 1998, 10:25–41.

    Article  Google Scholar 

  16. Hitchins RN, Bell DR, Woods RL, Levi JA: A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis. J Clin Oncol 1987, 5:1655–1662.

    PubMed  CAS  Google Scholar 

  17. Gajjar A, Fouladi M, Walter AW, et al.: Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors. J Clin Oncol 1999, 17:1825–1828.

    PubMed  CAS  Google Scholar 

  18. Chamberlain MC, Kormanik PA: Prognostic significance of 111Indium DTPA CSF flow studies in leptomeningeal metastases. Neurology 1996, 46:1674–1677.

    PubMed  CAS  Google Scholar 

  19. Mason WP, Yeh SDJ, DeAngelis LM: 111Indium-diethylenetriamine pentacetic acid cerebrospinal fluid flow studies predict distribution of intrathecally administered chemotherapy and outcome in patients with leptomeningeal metastases. Neurology 1998, 50:438–443.

    PubMed  CAS  Google Scholar 

  20. Chamberlain MC. Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol 1998, 38:135–140.

    Article  PubMed  CAS  Google Scholar 

  21. Hannssens PEJ, Lagerwaard FJ, Levendag PC: Principles of radiotherapy of neoplastic meningitis. J Neurooncol 1998, 38:145–150.

    Article  Google Scholar 

  22. Sandberg DI, Bilsky MH, Souwedaine MM, et al.: Ommaya reservoirs for the treatment of leptomeningeal metastases. Neurosurgery 2000, 47:49–55. Addresses the techniques and complications associated with Ommaya reservoir placement.

    Article  PubMed  CAS  Google Scholar 

  23. Berweiler U, Krone A, Tonn JC: Reservoir systems for intraventricular chemotherapy. J Neurooncol 1998, 38:141–143.

    Article  PubMed  CAS  Google Scholar 

  24. Slavc I, Schuller E, Czech T, et al.: Intrathecal mafosfamide for pediatric brain tumors with meningeal dissemination. J Neurooncol 1998, 38:213–218.

    Article  PubMed  CAS  Google Scholar 

  25. Blaney SM, Poplack DG: New cytotoxic drugs for intrathecal administration. J Neurooncol 1998, 38:219–223.

    Article  PubMed  CAS  Google Scholar 

  26. Friedman HS, Petros W, Rich JN, et al.: Phase I trial of intrathecal Spartaject busulfan for patients with neoplastic meningitis. Proc Amer Soc Clin Oncol 2001, 20:57.

    Google Scholar 

  27. Chamberlain MC: A phase 2 trial of intra-CSF alpha interferon in the treatment of neoplastic meningitis. Neurology 2001, 56(suppl):A476.

    Google Scholar 

  28. Herrlinger U, Weller M, Schabet M: New aspects of immunotherapy of leptomeningeal metastasis. J Neurooncol 1998, 38:233–239.

    Article  PubMed  CAS  Google Scholar 

  29. Coakham HB, Kemshead JT: Treatment of neoplastic meningitis by targeted radiation using 1311-radiolabelled monoclonal antibodies. J Neurooncol 1998, 38:225–232.

    Article  PubMed  CAS  Google Scholar 

  30. Vrionis FD: Gene therapy of neoplastic meningitis. J Neurooncol 1998, 38:241–244.

    Article  PubMed  CAS  Google Scholar 

  31. Stockhammer G, Poewe W, Surgstaller S, et al.: Vascular endothelial growth factor in CSF: a biological marker for carcinomatous meningitis. Neurology 2000, 54:1670–1675.

    PubMed  CAS  Google Scholar 

  32. Bleyer WA: Clinical pharmacology of intrathecal methotrexate. II. An improved dosage regimen derived from age-related pharmacokinetics. Cancer Treat Rep 1977, 46:1419–1425.

    Google Scholar 

  33. Friedberg MH, Glantz MJ, Klempner MS, et al.: Specific matrix metalloproteinase profiles in the cerebrospinal fluid correlated with the presence of malignant astrocytomas, brain metastases and carcinomatous meningitis. Cancer 1998, 82:923–930.

    Article  PubMed  CAS  Google Scholar 

  34. van Oostenburge RJ, Hopman AHN, Ramaekers FCS, Twijnstra A: In situ hybridization: a possible diagnostic aid in leptomeningeal metastases. J Neurooncol 1998, 38:127–133.

    Article  Google Scholar 

  35. Posner JB: Neurologic Complications of Cancer. Philadelphia: FA Davis Company; 1995:163.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, 10021, New York, NY, USA

    Lauren E. Abrey MD

Authors
  1. Lauren E. Abrey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abrey, L.E. Leptomeningeal neoplasms. Curr Treat Options Neurol 4, 147–156 (2002). https://doi.org/10.1007/s11940-002-0023-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-002-0023-3

Keywords

Search

Navigation