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Leptomeningeal metastasis.
Semin Neurol 2010; 30(3):236-44SN

Abstract

Leptomeningeal metastasis occurs in ~5% of all patients with cancer and is the third most common metastatic complication of the central nervous system. Staging of leptomeningeal metastasis includes contrast-enhanced brain and spine magnetic resonance imaging and radionuclide cerebrospinal fluid (CSF) flow study. Treatment, when clinically indicated, often requires administration of involved-field radiotherapy to bulky or symptomatic disease sites as well as intra-CSF and systemic chemotherapy. The use of high-dose systemic therapy may benefit selected patients with breast- or lymphoma-related leptomeningeal metastasis and obviate the need for intra-CSF chemotherapy. Intra-CSF drug therapy primarily utilizes one of three chemotherapeutic agents (e.g., methotrexate, cytosine arabinoside, and thiotepa) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Beginning to be utilized are novel intra-CSF agents, such as the targeted monoclonal antibodies rituximab (anti-CD20 for B-cell lymphoma-related leptomeningeal metastasis) and trastuzumab (anti-Her2/neu for breast cancer-related leptomeningeal metastasis). Although treatment of leptomeningeal metastasis is palliative with median patient survival of 2 to 3 months, treatment may afford stabilization and protection from further neurologic deterioration in patients with leptomeningeal metastasis.

Authors+Show Affiliations

Department of Neurology and Neurological Surgery, Division of Neuro-Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1023, USA. chambemc@u.washington.edu

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20577930

Citation

Chamberlain, Marc C.. "Leptomeningeal Metastasis." Seminars in Neurology, vol. 30, no. 3, 2010, pp. 236-44.
Chamberlain MC. Leptomeningeal metastasis. Semin Neurol. 2010;30(3):236-44.
Chamberlain, M. C. (2010). Leptomeningeal metastasis. Seminars in Neurology, 30(3), pp. 236-44. doi:10.1055/s-0030-1255220.
Chamberlain MC. Leptomeningeal Metastasis. Semin Neurol. 2010;30(3):236-44. PubMed PMID: 20577930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leptomeningeal metastasis. A1 - Chamberlain,Marc C, Y1 - 2010/06/24/ PY - 2010/6/26/entrez PY - 2010/6/26/pubmed PY - 2010/10/19/medline SP - 236 EP - 44 JF - Seminars in neurology JO - Semin Neurol VL - 30 IS - 3 N2 - Leptomeningeal metastasis occurs in ~5% of all patients with cancer and is the third most common metastatic complication of the central nervous system. Staging of leptomeningeal metastasis includes contrast-enhanced brain and spine magnetic resonance imaging and radionuclide cerebrospinal fluid (CSF) flow study. Treatment, when clinically indicated, often requires administration of involved-field radiotherapy to bulky or symptomatic disease sites as well as intra-CSF and systemic chemotherapy. The use of high-dose systemic therapy may benefit selected patients with breast- or lymphoma-related leptomeningeal metastasis and obviate the need for intra-CSF chemotherapy. Intra-CSF drug therapy primarily utilizes one of three chemotherapeutic agents (e.g., methotrexate, cytosine arabinoside, and thiotepa) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Beginning to be utilized are novel intra-CSF agents, such as the targeted monoclonal antibodies rituximab (anti-CD20 for B-cell lymphoma-related leptomeningeal metastasis) and trastuzumab (anti-Her2/neu for breast cancer-related leptomeningeal metastasis). Although treatment of leptomeningeal metastasis is palliative with median patient survival of 2 to 3 months, treatment may afford stabilization and protection from further neurologic deterioration in patients with leptomeningeal metastasis. SN - 1098-9021 UR - https://www.unboundmedicine.com/medline/citation/20577930/abstract/Leptomeningeal_metastasis_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0030-1255220 DB - PRIME DP - Unbound Medicine ER -