Open AccessNeoplastic Meningitis from Solid Tumors: New Diagnostic and Therapeutic Approaches
Author(s) -
Lombardi Giuseppe,
Zustovich Fable,
Farina Patrizia,
Della Puppa Alessandro,
Manara Renzo,
Cecchin Diego,
Brunello Antonella,
Cappetta Alessandro,
Zagonel Vittorina
Publication year - 2011
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2011-0101
Subject(s) - medicine , meningitis , magnetic resonance imaging , positron emission tomography , meningeal carcinomatosis , intensive care medicine , radiology , oncology , cerebrospinal fluid , surgery
Learning Objectives After completing this course, the reader will be able to: 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 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.