Systemic chemotherapy, intrathecal chemotherapy, and symptom management in the treatment of leptomeningeal metastasis

Berg, Stacey L.; Chamberlain, Marc C.

doi:10.1007/s11912-003-0084-9

Cited by 31 publications

(27 citation statements)

References 101 publications

(155 reference statements)

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“…A randomized trial comparing DepoCyt ® with intrathecal methotrexate in patients with neoplastic meningitis showed similar response rates and a significantly greater time to neurological progression (58 days versus 30 days) [71]. Although a number of agents, including mafosfamide (a derivative of cyclophosphamide), busulfan, topotecan, diaziquinone, interferon, monoclonal antibodies, and interleukin-2, as well as gene therapy, are under active investigation, these are limited to use in the setting of experimental protocols and are not widely available [72]. There is no agreed upon standard regarding the best therapy.…”

Section: Manifestations Of Cns Metastases Other Than Brain Lmmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Chang

2003

The Oncologist

145

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The brain, cranial nerves, leptomeninges, spinal cord, and eye compose the central nervous system (CNS) and are at risk for the development of metastases from breast cancer. Such metastases are diagnosed on the basis of clinical suspicion and substantiated by neuroimaging, resection when indicated, and sampling of cerebrospinal fluid when leptomeningeal metastasis (LM) is suspected. Treatment is aimed at palliation of symptoms and preservation of neurologic function. Historically, conventional radiation therapy has been the mainstay of palliative treatment for brain, cranial nerve, spinal cord, and ocular metastases. However, additional treatment options for brain metastases have been brought about by technological advances in surgery to resect brain metastases, and stereotactic radiosurgery (SRS) to focally irradiate metastases, both of which have been substantiated by data from randomized trials. Ongoing research is aimed at refining criteria to select which patients with brain metastases should undergo surgery and SRS and how these focal therapies should be optimally integrated with whole-brain radiotherapy. Therapy for LM must carefully balance the potential risks and perceived benefits associated with CNS-directed therapies. Despite advances in neuroimaging, surgery, and radiation therapy, novel treatments are needed to improve the effectiveness of treatments for CNS metastases, especially LM, while reducing attendant neurotoxicity.

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Section: Manifestations Of Cns Metastases Other Than Brain Lmmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Chang

2003

The Oncologist

145

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“…The single most useful laboratory test in diagnosing LC is cytologicalexaminationoftheCSF,whichisusuallyobtained byLP [4].Thisgoldstandard [9,[17][18][19]isanextremelyinsensitivetest;40-50%ofpatientswithpathologicallyprovenLC havenegativeCSFcytology [2,4,6,11,20,21].Repeatedsamplingenhancesthediagnosticyield(from50to90%between first and third spinal tap), justifying the recommendation to performatleast3LPsoverseveraldaysiftheinitialcytology isnegative[3, 5,6,11,14,17,22].ButCSFcytologyispersistentlynegativeinabout10%ofpatientswithLC,andtheCSF is abnormal in nearly all patients with LC regardless of the resultsofCSFcytology [2][3][4]6,10,17,22].…”

Section: Diagnostic Studiesmentioning

confidence: 99%

“…Chemotherapymayreducesymptomswhendiseaseistreated early [20] and, of note, encephalopathies may improve dramaticallywithtreatment [6,10].Earlyrecognitionandtimely treatmentarecriticaltopreservingneurologicfunctions [10,19]andareimportantifneurologicsymptomsandsignsareto beresolved.TreatmentofLCoftenaffordsstabilizationand protection from further neurologic deterioration in patients [4,11,14].…”

Section: Therapymentioning

confidence: 99%

“…MostITtreatmentregimensconsistofsingle-agentadministration(MTX8mg/m 2 or12-15mgfixeddose)2or3times weekly [5].InpatientswithLC,theresponsetotreatmentis primarilyafunctionofCSFcytologyandsecondarilyofclinicalimprovementofneurologicsymptoms [11,20].Inthefirst study regarding LC exclusively attributable to metastatic NSCLC, 43% of 32 patients (17 patients) responded to IT MTX [15].…”

Section: Intrathecal Chemotherapymentioning

confidence: 99%

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Very Late and Isolated Leptomeningeal Relapse of a Pulmonary Adenocarcinoma Presenting as Dementia

et al. 2011

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“…There are several studies in the literature that have addressed radiation therapy, systemic chemotherapy and intrathecal chemotherapy specifically for the treatment for brain metastasis with/without leptomeningeal seeding (3,(41)(42)(43). However, the number of published reports on the palliative surgical management of hydrocephalus secondary to brain metastasis and/or leptomeningeal seeding from malignant tumors is currently limited (6,12,17,18).…”

Section: Introductionmentioning

confidence: 99%

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Nigim

Critchlow

Kasper

2015

Molecular and Clinical Oncology

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Abstract. Approximately 1-5% of patients with cerebral metastasis and ~40% of patients with primary brain tumors suffer from hydrocephalus. These patients often exhibit a poor prognosis. The aim of the present study was to reassess the validity of ventriculoperitoneal shunting (VPS) with the assistance of the general surgeon in oncological patients. A total of 59 patients underwent first-time VPS at the Beth Israel Deaconess Medical Center (Boston, USA) between 2004 and 2012; 40 patients had hydrocephalus from brain metastasis and 19 from primary tumors. The analyzed independent variables included demographics, body mass index, past medical history, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score and surgical technique; the dependent variables were postoperative symptoms and occurrence, cause and time of shunt failure. The outcomes were analyzed with the t-test and Kaplan-Meier estimates for shunt survival. The mean age of the patients was 57.2 years and the mean operative time was 50.4 min. Symptomatic palliation was achieved in 93% of the cases; patients with severe symptoms, such as debilitating headaches, nausea and vomiting, benefited significantly from VPS. The mean follow-up time was 6.3 months; complications occurred in only 7 patients (11.8%) during follow-up: 2 in the proximal shunt (1 infection and 1 obstruction), both requiring revision, 1 infection in the distal catheter requiring shunt removal, 2 cases of intracerebral bleeding that were monitored with computed tomography scans, 1 wound infection treated with antibiotics and 1 valve complication that required temporary revision. The initial and 3-month KPS scores were 65±16.4 and 75±16.0, respectively. The mean overall shunt survival was 6.4 months (range, 1.0 day-76.0 months) from the placement of the VP shunt. At 3 months after VPS, 93.5% of the patients remained alive with functioning shunts and at 1 year 87% of the shunts were still functioning. In conclusion, VPS remains a valid option for cancer patients with low KPS, as it improves the quality of life in such patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease, since shunt patency outlasts the overall survival of nearly all patients.

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Systemic chemotherapy, intrathecal chemotherapy, and symptom management in the treatment of leptomeningeal metastasis

Cited by 31 publications

References 101 publications

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Very Late and Isolated Leptomeningeal Relapse of a Pulmonary Adenocarcinoma Presenting as Dementia

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

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