Diagnosis and treatment of leptomeningeal carcinomatosis in solid tumors

Czech version

Authors: F. Janků; L. Petruželka
Authors‘ workplace: Onkologická klinika 1. LF UK a VFN, Praha
Published in: Cesk Slov Neurol N 2007; 70/103(1): 23-29
Category: Review Article

Vytvořeno s podporou výzkumného záměru MSM0021620808

Overview

Leptomeningeal carcinomatosis or leptomeningeal metastases occur in approximately 4-15% patients with solid tumors. Nowadays, this disorder is more frequently diagnosed with longer survival of cancer patients and constantly improving diagnostic methods. The most common cancers to involve leptomeninges are breast cancer, lung cancer and melanoma. Clinically, patients with leptomeningeal carcinomatosis present with various neurological symptoms including headache, back pain, head nerves injuries, diplopia etc. Cerebrospinal fluid (CSF) cytology is a principal method in diagnosis. Magnetic resonance imaging is a major method among radiologic studies. Without treatment, the median survival of untreated patients is 4-6 weeks and death occurs from progressive neurologic dysfunction. Intrathecal chemotherapy with or without involved field radiotherapy may extend survival up to 4 to 6 months. Chemotherapy is usually administered via subcutaneous reservoir and ventricular catheter. Radionuclide CSF flow study should precede the treatment. At present, methotrexate is mostly used for intrathecal chemotherapy of solid tumors. This therapy is frequently accompanied by an arachnoiditis, leukoencephalopathy, myelopathy or infection.

Key words:
leptomeningeal carcinomatosis; leptomeningeal metastases; intrathecal chemotherapy; methotrexate, cytosine arabinosid; cerebrospinal fluid

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