Neoplastic meningitis from solid tumors: a prospective clinical study in lombardia and a literature review on therapeutic approaches

Abstract

Neoplastic dissemination to the leptomeninges is an increasingly common occurrence in patients with both haematological and solid tumors arising outside the central nervous system. Both refinement of diagnostic techniques (Magnetic resonance imaging) and increased survival in patients treated with targeted therapies for systemic tumors account for this increased frequency. Cerebrospinal fluid cytological analysis and MRI confirm clinical diagnosis based on multifocal central nervous system signs/symptoms in a patient with known malignancy. Overall survival in patients with leptomeningeal neoplastic dissemination from solid tumors is short, rarely exceeding 3-4 months. However, selected patients may benefit from aggressive therapies, Apart from symptomatic treatment, intrathecal chemotherapy is used, with both free (methotrexate, Thiotepa, AraC) and liposomal antitumor agents (liposomal AraC). Palliative radiotherapy is indicated only in cases of symptomatic bulky disease, surgery is limited to positioning of Ommaya recervoirs or C5F shunting. We report clinical data on a cohort of 26 prospectively followed patients with neoplastic leptomeningitis followed in Lombardia, Italy, in 2011. Prognostic factors and pattern of care are reported.

Figure 1

Figure 2

Postcontrast T1-weighted MRI images of diffuse enhancement in cerebral sulci and linear enhancement surrounding the dorsolumbar spinal cord and the lumbosacral roots in a 28-yr-old female with breast cancer.

Figure 3

CSF cytology with stain with peroxidase-conjugated anticytokeratin antibody and counterstain with haematoxylin (courtesy of Dr. E. Corsini, Fondazione IRCCS Istituto Neurologico Besta, Milano).