This chapter discusses the epidemiology, pathogenesis. Management of neoplastic meningitis roth chinese clinical. Three cases of neoplastic meningitis initially diagnosed with. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. Neoplastic meningitis nm from solid tumors is an advanced malignancy with poor prognosis. Notwithstanding frequent focal signs and symptoms, nm is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid csf compartments. Most cases present with multifocal neurological symptoms that vary according to the central nervous system territory involved. Intrathecal chemotherapy is a reliable treatment, and we have obtained. Neoplastic meningitis nm is a devastating complication of solid tumors with poor outcome. Neoplastic meningitis nm is a common problem in neurooncology occurring. Neoplastic meningitis is a complication of the cns that occurs in 35% of patients with cancer and is characterised by multifocal neurological signs and symptoms.
Nm is a disease affecting the entire neuraxis, so staging and treatment need to encompass all cerebrospinal fluid csf compartments. Neoplastic meningitis nm results from the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid csf compartment. Nspc is at the forefront of advanced brain cancer treatments and participates in clinical trials to help in the search for cures to these lifechanging. Their topics include the pathology and molecular genetics of common brain tumors, malignant gliomas in adults, low grade astrocytomas, pediatric neurooncology, the managing intramedullary spinal cord tumors, medical complications in the management of brain tumor, brain metastases, neoplastic meningitis, the neurotoxicity of chemotherapy, paraneoplastic disorders, and neurological.
Neoplastic meningitis presenting with dysphagia and bilateral. Neoplastic meningitis nm is diagnosed by the presence of malignant cells in the. Clinical presentation, diagnosis, and radiological. Diagnosis and outcome measures in trials for neoplastic meningitis. We therefore reevaluated the sensitivity of gadolinium gdenhanced mri and cerebrospinalfluid csfcytology and the relevance of tumor type and csf cell count.
Download pdf background neoplastic meningitis nm also known as leptomeningeal metastases, meningeal carcinomatosis, or leukemic meningitis, is a common oncologic complication representing spread of tumor cells to the subarachnoid space sas. We report 3 patients with nm, who were misdiagnosed with infectious meningitis in emergency department ed. While this diagnosis carries a poor prognosis, early diagnosis and treatment can prevent neurologic deficits and extend survival with good quality of life. Phase i trial of intrathecal spartaject busulfan in children. Intrathecal administration of 1 i radiolabelled monoclonal. Notwithstanding frequent focal signs and symptoms, nm is a disease that affects the entire neuraxis. Background neoplastic meningitis nm also known as leptomeningeal metastases, meningeal carcinomatosis, or leukemic meningitis, is a. Neoplastic meningitis journal of clinical oncology asco journals. Clinical presentation, diagnosis, and radiological findings of. It is found in approximately 510% of all patients with malignant tumors and is a condition frequently diagnosed. Schluterman et al 1 retrospectively described 23 patients with multiple myeloma mm and neoplastic meningitis nm from the university of arkansas for medical sciences, a nationally recognized center of excellence for the care and treatment of patients with mm. Mri for detecting neoplastic and nonneoplastic meningitis. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells.
Pdf neoplastic meningitis nm is a devastating complication of solid tumors with poor outcome. However, treatment can result in significant palliation of the cns and is best. Neoplastic meningitis needs to remain in the differential diagnosis of any cancer patient with new, particularly multifocal, neurologic symptoms. Leptomeningeal dissemination neoplastic meningitis can occur in patients without known brain parenchymal metastases. Demonstration of neoplastic cells in the csf is key to the diagnosis. Nm is not infrequent, and is becoming more common as cancer patients live longer. Diagnosis and outcome measures in trials for neoplastic. Carcinomatous meningitis is defined as metastatic infiltration of cerebrospinal fluid csf and leptomeninges by cancer with primary focus at some other site. Controlled clinical trials are largely lacking which results in various nonstandardized treatment regimens. In a study of leptomen ingeal metastases from breast cancer and a study of neoplastic meningitis due to several different primary tumors, researchers found that the median karnofsky performance status was approximately 70%. It is the is the third most common cause of central nervous system cns metastases after brain metastases and epidural spinal cord compression 1. I would like to submit a letter to the editor regarding the article multiple myeloma invasion of the central nervous system, which recently appeared in the a rchives schluterman et al 1 retrospectively described 23 patients with multiple myeloma mm and neoplastic meningitis nm from the university of arkansas for medical sciences, a nationally recognized center of excellence for the. Neoplastic meningitis is recognized clinically in 4% to 7% of patients with extraneural cancer, but it remains.
N2 improved treatment of systemic cancers has prolonged the lives of many patients but has also led to increased incidence of neoplastic meningitis. Six patients with neoplastic melanomatous meningitis were studied. Some randomized clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic parameters, response evaluation and primary endpoints. It is most often recognized in patients with leukemia, breast cancer, lymphomas, and smallcell cancer of the lung, although it may be seen with virtually any malignancy. Neoplastic meningitis is an event in the course of cancer with a. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells and is becoming. References to any names, marks, products, or services of third parties or hypertext links to third. Intrathecal dexamethasone and methotrexate treatment of. Neoplastic meningitis is an increasingly recognized complication of advanced metastatic cancer and, if left undiagnosed or untreated, is characterized by rapid neurologic deterioration and death. The most frequent primary tumor types that give rise to brain metastases include lung cancer, melanoma, breast cancer, and renal cell carcinoma.
Clinical presentation, diagnosis, and radiological findings. Patients with aids were younger and predominantly male. A 68yearold man visited our ed with a 3month history of headache. Diagnosis contrastenhanced magnetic resonance imaging mri is the best method to diagnose malignant cns involvement. Nm is a frequent complication of systemic cancer and occurs in 4%15% of all patients with solid tumors. Neoplastic meningitis is mostly seen in patients with breast cancer, lung cancer, and melanoma. The prognosis for patients who develop neoplastic meningitis or leptomeningeal dissemination of cancer cells remains poor. Neoplastic meningitis is a solid tumor at the advanced stage during which patients usually has severe pain and must administrate painkillers frequently. Neoplastic meningitis is recognized clinically in 4% to 7% of patients with extraneural cancer, but it remains dramatically underdiagnosed. Neoplastic meningitis palliative care network of wisconsin. Csf infections complicating the management of neoplastic. Neoplastic meningitis, current neurology and neuroscience. Neoplastic meningitis, current treatment options in.
Leptomeningeal metastases in solid tumors surgical neurology international, vol. Neoplastic meningitis neoplastic meningitis chamberlain, marc 20080529 00. Neoplastic meningitis nm is a common problem in neurooncology, occurring in approximately 5% of all patients with cancer. Basically, neoplastic meningitis may affect all patients with a malignant tumor but is most common in patients affected by lung cancer, breast carcinoma, melanoma or hematologic neoplasms such as lymphoma and leukemia. Although csf cytology and mri are standard methods to diagnose neoplastic meningitis nm, this complication of neoplastic disease remains difficult to detect. Interdisciplinary management of central nervous system.
Some randomized clinical trials have been conducted. Fourteen patients median age, 57 years with nm were treated with the standard of care i. Background neoplastic meningitis nm also known as leptomeningeal metastases, meningeal carcinomatosis, or leukemic meningitis, is a common oncologic complication representing spread of tumor cells to the subarachnoid space sas. A phase i trial of intrathecal spartaject busulfan supergen, inc. Neoplastic meningitis refers to infiltration of the meninges by tumor cells. Bronchogenic carcinoma presenting primarily with central nervous symptoms is even more uncommon. Interdisciplinary management of central nervous system metastasis and neoplastic meningitis. The continuous reassessment method was used to assign cohorts of. Neoplastic meningitis appears to be increasing in frequency with improvements in the treatment of many cancers.
For the contribution history and old versions of the redirected page, please see. Leptomeningeal cancer also called leptomeningeal carcinomatosis, leptomeningeal disease lmd, leptomeningeal metastasis, neoplastic meningitis, meningeal metastasis and meningeal carcinomatosis is a rare complication of cancer in which the disease spreads from the original tumor site to the meninges surrounding the brain and spinal cord, this leads to an inflammatory response, hence the. Neoplastic meningitis neurological surgery long island ny. This chapter discusses the epidemiology, pathogenesis, clinical features, diagnosis, prognosis, and treatment of neoplastic meningitis. With mri and csf study, he was diagnosed with tuberculous meningitis. Neoplastic meningitis nm is a common problem in neurooncology, occurring in. Watch the video lecture meningitis and encephalitis. Basically, neoplastic meningitis may affect all patients with a malignant tumor but is most common in patients affected by lung cancer, breast carcinoma, melanoma or hematologic neoplasms such. Csf infections complicating the management of neoplastic meningitis. Neoplastic meningitis nm is diagnosed by the presence of malignant cells in the cerebrospinal fluid csf. Pdf intrathecal dexamethasone and methotrexate treatment. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells and is becoming more common as cancer patients live longer. Some clinical features are secondary to elevated intracranial pressure and include headaches, papilledema, and altered mental. Diagnosis is problematic because the disease is commonly the result of pleomorphic manifestations of neoplastic meningitis and cooccurrence of disease at other sites.
The frequency of neoplastic meningitis is increasing because of heightened clinical suspicion, improved neuroimaging techniques, and longer survival in patients with extraneural cancer longer survival allows residual tumor cells within central nervous. Currently, four therapeutic agents are available for intrathecal treatment. Publish before print journal of neurosurgery journal of neurosurgery. If the inline pdf is not rendering correctly, you can download the pdf file here. Leptomeningeal dissemination of tumor cells, also referred to as neoplastic meningitis, is most frequently seen in patients with latestage cancer and mostly associated with a poor prognosis. Commentary regarding neoplastic meningitis secondary to. May 29, 2008 neoplastic meningitis neoplastic meningitis chamberlain, marc 20080529 00.
This study analyzes the clinical and bacteriologic features of csf infections that occurred in patients with neoplastic meningitis treated with thiotepa and methotrexate administered through a subcutaneous reservoir and ventricular catheter srvc. Symptoms will vary based on the location of lesions. The terms neoplastic meningitis and carcinomatous meningitis refer to the dissemination of cancer cells within the leptomeningeal space. Brain metastases and neoplastic meningitis sciencedirect. Neoplastic meningitis presenting with dysphagia and.
Fifteen patients with neoplastic meningitis received a single intrathecal injection of between 11 and 60 mci of a 1i radiolabelled monoclonal antibody moab, chosen for its immunoreactivity to. May 01, 20 neoplastic meningitis is diagnosed based on three factors. Intrathecal topotecan in adult patients with neoplastic. Neoplastic meningitis definition of neoplastic meningitis. Based on the origin of the primary tumor, the condition may be categorized as carcinomatous, lymphomatous, or leukemic meningitis. The rarity of this central nervous system complication and the volume of patients. The addition of monoclonal antibody immunocytology to conventional techniques significantly improved the diagnostic sensitivity of csf cytology, allowing for earlier and therefore more effective palliative. However, even after a week of treatment, the patients symptoms did not. Neoplastic meningitis nm is a common problem in neurooncology occurring in approximately 5% of all patients with cancer and is the third most common site of central nervous system metastases.
Phase i trial of intrathecal spartaject busulfan in. Bronchogenic carcinoma presenting as carcinomatous meningitis. The diagnosis of nm often leads to palliative treatment that is intended to preclude the additional discomfort with aggressive treatment. Neoplastic meningitis also referred to as meningeosis. Longterm survival is occasionally observed in patients with neoplastic meningitis nm accompanying breast cancer % oneyear and 6% 2year survival, melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months.
The contents of the meningeal carcinomatosis page were merged into neoplastic meningitis on 9 september 2019. Nm is a disease affecting the entire neuraxis, so staging and treatment need to. Three cases of neoplastic meningitis initially diagnosed. Brain metastases and neoplastic meningitis clinical gate.
Some randomized clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic par. Neoplastic meningitis knowledge for medical students and. Thus, the diagnosis and treatment of neoplastic meningitis present challenges for the clinical oncologist. The diagnosis of neoplastic meningitis is based on clinical signs and symptoms, laboratory. A retrospective analysis of 41 patients with cryptococcal meningitis and aids or neoplastic disease was done. It affects approximately 5% of all patients with cancer. Useful tests to establish diagnosis and guide treatment include. Neoplastic meningitis is an event in the course of cancer with a variable. Treatment of nm aims to improve neurological symptoms and extend overall survival os, especially when the disease is diagnosed early on.
Neoplastic meningitis treatments are considered palliative, with an emphasis on limiting symptoms such as neurologic deterioration and extending quality of life. Treatment of nm involves involvedfield radiotherapy of bulky or symptomatic disease sites and intracsf drug therapy. Intrathecal chemotherapy is a reliable treatment, and we have obtained some experiences in the treatment of nm with intrathecal dexamethasone and methotrexate it dxm and mtx. Symptoms are often multifocal, involving cerebral, spinal, and cranial nerve components of the neuroaxis see table. Neoplastic meningitis nm is a common problem in neuro. The diagnosis of this complication of malignant disease rests on the demonstration of malignant cells within the csf. Neoplastic meningitis chamberlain 2008 the oncologist wiley. Intrathecal chemotherapy is a reliable treatment, and we have obtained some experiences in the treatment of nm with intrathecal dexamethasone and methotrexate it. Neoplastic meningitis nm developed 31 months after first diagnosis of simultaneous extra and intracranial recurrence of kidney cancer and surgical resection of a cerebellar metastasis. Neoplastic meningitis is the infiltration of the leptomeninges and subarachnoid space by tumor cells occurring in 3% to 5% of patients with systemic malignancies.