Neoplastic Meningitis from Solid Tumors: New Diagnostic and Therapeutic Approaches

Abstract

After completing this course, the reader will be able to:1. Compare the use of i.t. therapy and systemic therapies for patients with neoplastic meningitis. Describe new drugs showing promise for neoplastic meningitis.This article is available for continuing medical education credit at CME.TheOncologist.com. The Oncologist CME Program is located online at http://cme.theoncologist.com/. To take the CME activity related to this article, you must be a registered user. CME CME ABSTRACT Neuro-OncologyThe Oncologist 2011;16:1175-1188 www.TheOncologist.com In this review, we analyze the most recent and interesting developments on diagnostic and therapeutic approaches. The Oncologist 2011;16:1175-1188

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

“…Glial fibrillary acidic protein assessed by immunohistochemistry in CSF may facilitate the identification of malignant glial cells. 1,[63][64][65]97 Several studies have demonstrated that the sensitivity of flow cytometry is several-fold higher than that of cytology for detecting CSF leukemia or lym-phoma. 98,99 Flow cytometry allows for the early detection of neoplastic meningitis before the onset of clinical symptoms and CSF pleocytosis; therefore, its use may enable more effective treatment.…”

“…100 Future consensus regarding standardized antibody panels for flow cytometry that uniformly define positivity is likely to advance the early detection of neoplastic meningitis and will help permit its broader clinical applicability. 1,[63][64][65] Another group of researchers studied patients with epithelial cell cancers to explore how flow cytometry immunophenotyping contributed to the diagnosis and prognosis of neoplastic meningitis. 101 CSF samples from patients diagnosed with neoplastic meningitis were studied using flow cytometry immunophenotyping.…”

“…It occurs in 4% to 15% of solid tumors and up to 20% of lymphomas and leukemias, and it is associated with significant morbidity and short survival rates (range, several weeks to 8 months). 1,2 Neoplastic meningitis is characterized by the diffuse involvement of the leptomeninges (pia and arachnoid), the subarachnoid space, and the cerebrospinal fluid (CSF) by malignant cells, and it occurs through the hematogenous invasion of the subarachnoid space and ventricles or through direct extension from bone and brain lesions, or, in some cases, with local spread through the dura along perineural and perivascular spaces. 3 The most frequent primary solid tumors associated with neoplastic meningitis are breast cancer, non-small-cell lung cancer, and malignant melanoma.…”

Intra-CSF administration of chemotherapy medications

“…It is diagnosed in 1-5 % of patients with solid tumors, 5-15 % of patients with leukemia and lymphoma, and 1-2 % of patients with primary brain tumors [2]. The most common solid tumors spreading to leptomeninges are breast cancer (43 %), lung cancer (31 %), and melanoma (6 %) [3]. Among hematologic malignancies, LMC is most commonly seen in acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), and high grade lymphomas (Burkitt's, large cell) [4].…”

“…Among hematologic malignancies, LMC is most commonly seen in acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), and high grade lymphomas (Burkitt's, large cell) [4]. LMC usually represents a terminal event with median survival ranging from 2 to 6 months [3]. Most untreated patients with LMC from solid tumors die within 3-6 weeks due to progressive neurologic dysfunction [3,5].…”