Méthotrexate intrathécal dans les méningites carcinomateuses du cancer du sein – Expérience avec le protocole utilisé à l’hôpital Saint-Louis

Carcinomatous Meningitis due to Ovarian and Gastric Cancers: Case Report and Literature Review on the Therapeutic Approach to this Rare Cancer Complication

“…However, the symptoms at diagnosis can be very diverse in the case of very extensive meningeal involvement or diffuse peri-medullary leptomeningeal involvement. This is in agreement with the data of Cochereau et al, In a retrospective series of 41 patients followed up for carcinomatous leptomeningitis, they found that headache was indeed by far the most frequent symptom at diagnosis, but also that symptoms related to cranial pair involvement or medullary or radicular leptomeningeal involvement were also relevant and could be the sole indicators of Carcinomatous meningitis [7]. Thus, in current clinical practice, a meticulous neurological examination is essential and a hypothesis of Carcinomatous meningitis should systematically be evoked when neurological symptoms of all types (central or peripheral) appear in patients followed for cancers, and not only for cancers known to have the propensity to metastasise to the cerebral-meningeal level.…”

“…The prognosis for Carcinomatous meningitis is generally poor with survival rarely exceeding 4 months. In their series of 41 patients who developed Carcinomatous meningitis in breast cancer, Cochereau et al, found that patients had a median survival of 4 months after treatment with intrathecal methotrexate [7]. Similar results were found by Boogerd et al, who found a median survival of 18.3 weeks with intrathecal methotrexate and 30.3 weeks with non-intrathecal methotrexate [10].…”

“…This delay was 8.1 months in the series of Rouviere D. et al, with exclusively pulmonary primary cancers [8]. Cochereau et al, found a delay of 7.1 months with extremes ranging from 10 days to 34 months after the diagnosis of breast cancer [7]. However, rare cases of inaugural Carcinomatous meningitis are also described in the literature In the presence of a clinical situation suggestive of Carcinomatous meningitis, an imaging work-up is useful and should be performed as a matter of urgency.…”