Intensity Modulated Radiotherapy in Complex Treatment of Leptomeningeal Disease of Extracranial Solid Neoplasms

Leptomeningeal metastases (LM) are a severe consequence of metastatic distribution of solid malignant tumors. The purpose of this article is to highlight the importance of the intensity modulated radiotherapy (IMRT) to achieve prolonged local tumor control (LTC) in patients with LM. We present five clinical cases of leptomeningeal disease (LMD) in two patients with breast cancer (BC) and and in another three with malignant melanoma, laryngeal and renal carcinoma. The healing results after intensity modulated whole-brain radiotherapy (IM-WBRT) up to TD 40 Gy with DD 2 Gy, followed by boost radiotherapy (boost-RT) up to TD 50 Gy-54 Gy in the bulky brain metastases was presented. In BC LMD, the concominant RT with targeted therapy (TT) of trastuzumab and denosumab was performed. Leptomeningeal metastases have a poor prognosis, but precise IMRT with the realization of tolerant doses in normal brain structures and cancericidal doses in pathological brain areas achieves prolonged LTC for one year after RT with good quality of life. LMD in solid tumors requires an individual radiotherapeutic approach on a different target volume and necessary radiation doses, depending on the histological characteristic of tumor cells, as well as on the volume and localization of leptomeningeal metastases.