Neoplastic meningitis

Last updated: June 30, 2022

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Neoplastic meningitis is the infiltration of the meninges by tumor cells. It affects approximately 5% of all patients with cancer. Based on the origin of the primary tumor, the condition may be categorized as carcinomatous, lymphomatous, or leukemic meningitis. Some clinical features are secondary to elevated intracranial pressure and include headaches, papilledema, and altered mental status. Treatment is based on the type of primary tumor and the extent of disease. As neoplastic meningitis is usually a sign of advanced disease with systemic spread, the overall prognosis is poor.

References:[1][2][3][4]

References:[2]

General principles [5][6]

Neuroimaging [5][6][7]

Lumbar puncture [5][6][8]

Leptomeningeal biopsy [5][6]

  • Indications (rarely performed)
    • Negative CSF cytology
    • No prior history of cancer
    • Treatment is indicated but diagnosis is uncertain.
  • Confirmatory result: malignant cells

General principles [5][6]

Goals of treatment include improving or stabilizing neurological function and prolonging survival with a reasonable quality of life.

Anticancer therapies [5][6]

Treatment typically involves a combination of the following:

Neoplastic meningitis is usually a sign of advanced disease and therefore has a very poor prognosis.

Supportive care [2][5][6]

  1. Chamberlain MC, Nolan C, Abrey LE. Leukemic and lymphomatous meningitis: incidence, prognosis and treatment. J Neurooncol. 2005; 75 (1): p.71-83. doi: 10.1007/s11060-004-8100-y . | Open in Read by QxMD
  2. Chamberlain MC. Neoplastic meningitis. Oncologist. 2008; 13 (9): p.967-977. doi: 10.1634/theoncologist.2008-0138 . | Open in Read by QxMD
  3. Bomgaars L, Chamberlain MC, Poplack DG, Blaney SM. Leptomeningeal metastases. In: Oxford University Press, ed. Cancer in the nervous system. 2nd edition, ed. Oxford University Press Inc. ; 2002.
  4. Central Nervous System Complications of Leukemia. http://www3.mdanderson.org/depts/rpi/di/cnsclmi.html. Updated: February 1, 2002. Accessed: March 1, 2017.
  5. Le Rhun E, Weller M, Brandsma D, et al. EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours. Ann Oncol. 2017; 28 : p.iv84-iv99. doi: 10.1093/annonc/mdx221 . | Open in Read by QxMD
  6. Gleissner B, Chamberlain MC. Neoplastic meningitis. Lancet Neurol. 2006; 5 (5): p.443-452. doi: 10.1016/s1474-4422(06)70443-4 . | Open in Read by QxMD
  7. Fields MM. How to recognize and treat neoplastic meningitis. J Adv Pract Oncol. 2013; 4 (3): p.155-60.
  8. Djukic M, Trimmel R, Nagel I, et al. Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis. Fluids Barriers CNS. 2017; 14 (1). doi: 10.1186/s12987-017-0057-2 . | Open in Read by QxMD
  9. Ryken TC, McDermott M, Robinson PD, et al. The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2009; 96 (1): p.103-114. doi: 10.1007/s11060-009-0057-4 . | Open in Read by QxMD

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