Leptomeningeal metastasis from ovarian carcinoma successfully treated by the intraventricular administration of methotrexate

Abstract

A 60-year-old woman with a history of ovarian carcinoma and complaining of gait instability, dizziness, nausea, and a right temporal headache visited a neurologist. A diagnosis of leptomeningeal metastasis was made, based on the results of a cerebrospinal fluid examination. After the administration of intrathecal methotrexate, her neurological complaints disappeared. An Ommaya intraventricular reservoir was inserted, and methotrexate administration was continued for 11 months, until another recurrence was found in her pelvis. Although uncommon, the possibility of leptomeningeal metastasis from ovarian carcinoma should be considered; in such cases, treatment with intraventricular methotrexate may be effective and feasible and should be considered as a treatment strategy.

Epithelial Ovarian Carcinoma Associated with Metastases to Central Nervous System: Two Case Reports

“…Chemotherapy and radiotherapy have been used; most cases were treated with intrathecal chemotherapy using methotrexate, with or without whole-brain radiation therapy. In some reports, treatment with intrathecal methotrexate succeeded in prolonging the survival period from 6 to 18 months [ 30 – 33 ]. Regarding our case, we had no chance to treat with methotrexate for palliation as her condition declined rapidly after the diagnosis.…”

Cauda equina syndrome secondary to leptomeningeal metastases from recurrent primary peritoneal carcinoma

“…Involvement of the CNS is uncommon in EOCs with an incidence ranging from 0.29% to 4.5% [ 6 , 7 ]. Often, metastasis to the CNS is detected late in the disease process and despite advances in treatment options and radiation therapies, patient survival and prognosis remain poor [ 7 ].…”

“…Intrathecal chemotherapy with methotrexate has been used successfully to treat LM from ovarian cancer [ 6 ]. However, its effectiveness may be limited and its superiority over systemic treatment has not been established in randomised trials.…”

A report of Bell's Palsy triggered by leptomeningeal metastases from recurrent high grade serous ovarian cancer

“…Only a small number of cases of leptomeningeal metastasis associated with gynecologic malignancy can be found in the literature ( Asensio et al, 2009 ; Delord et al, 1998 ). Patients usually present with seizures, altered mental status, dementia, autonomic dysfunction, limb weakness/paresthesia and/or bowel and bladder issues ( Goto et al, 2008 ).…”

“…Life expectancy at time of presentation is often weeks to months. Usually, the cause of death in these patients is related to neurological tumor progression (15–87%) or systemic disease burden (10–64%) ( Goto et al, 2008 ). Due to the poor prognosis, if treatment is started, it should be for palliative purposes.…”