Neoplastic meningitis from solid tumors: New diagnostic and therapeutic approaches

Giuseppe Lombardi, Fable Zustovich, Patrizia Farina, Alessandro Della Puppa, Renzo Manara, Diego Cecchin, Antonella Brunello, Alessandro Cappetta, Vittorina Zagonel

Research output: Contribution to journalArticlepeer-review

Abstract

Neoplastic meningitis is a result of the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid. This event occurs in 4%-15% of all patients with solid tumors and represents an important prognostic factor for poor survival. Neoplastic meningitis should be diagnosed in the early stages of disease to prevent important neurological deficits and to provide the most appropriate treatment. Despite new diagnostic approaches developed in recent years, such as positron emission tomography-computed tomography and new biological markers, the combination of magnetic resonance imaging without and with gadolinium enhancement and cytology still has the greatest diagnostic sensitivity. Recently, no new randomized studies comparing intrathecal (i.t.) with systemic treatment have been performed, yet there have been a few small phase II studies and case reports about new molecularly targeted substances whose successful i.t. or systemic application has been reported. Trastuzumab, gefitinib, and sorafenib are examples of possible future treatments for neoplastic meningitis, in order to better individualize therapy thus allowing better outcomes. In this review, we analyze the most recent and interesting developments on diagnostic and therapeutic approaches.

Original languageEnglish
Pages (from-to)1175-1188
Number of pages14
JournalThe oncologist
Volume16
Issue number8
DOIs
Publication statusPublished - Aug 2011

Keywords

  • Brain tumors
  • Leptomeningeal carcinomatosis
  • Leptomeningeal disease
  • Neoplastic meningitis
  • Solid tumors
  • Targeted therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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