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Neuropsychiatric Disease and Treatment 2022To explore the disease manifestations and radiological characteristics of patients with meningeal carcinomatosis (MC) combined with myelopathy.
OBJECTIVE
To explore the disease manifestations and radiological characteristics of patients with meningeal carcinomatosis (MC) combined with myelopathy.
PATIENTS AND METHODS
The detailed medical information of patients who suffered from MC with myelopathy in record system were collected and reviewed.
RESULTS
In these patients, five cases were male and two cases were female. The age was from fifteen to fifty-seven years. In the course of disease, tumor cells were discovered in cerebrospinal fluid of three patients and in biopsy samples of four patients. Cerebrospinal fluid (CSF) test results showed white blood cell counts increased in seven patients, protein increased in six patients and glucose reduced in five patients. In addition, MRI revealed that the white matter abnormalities showed in all cases and pia mater was enhanced in four patients, meningeal enhanced was observed in three patients. All patients were given appropriate therapy during hospitalization. Follow-up result showed that all patients passed away two to five months after diagnosis.
CONCLUSION
MC causes spinal membrane, spinal nerve root to be involved besides, also can produce the matter of myelopathy. Early detection of intramedullary lesion is conducive to strengthening the awareness of the diagnosis of MC.
PubMed: 35615422
DOI: 10.2147/NDT.S329180 -
Medicina Clinica Sep 2016
Topics: Glioblastoma; Humans; Male; Meningeal Carcinomatosis; Middle Aged
PubMed: 26961392
DOI: 10.1016/j.medcli.2015.12.018 -
Clinical Neurology and Neurosurgery Sep 2018Leptomeningeal metastasis (LM), which occurs when malignant cells spread to the central nervous system, is becoming an increasingly common complication in patients with... (Review)
Review
Leptomeningeal metastasis (LM), which occurs when malignant cells spread to the central nervous system, is becoming an increasingly common complication in patients with breast cancer. Diagnosis and treatment of LM is challenging. Moreover, prognosis of patients with LM is poor, with a median survival of 6 months after diagnosis. This review highlights the strengths and limitations of currently available diagnostic tools and therapies for LM. The current treatments for LM, including radiotherapy, systemic therapy, and intrathecal treatment, aim to maintain the quality of life of patients by correcting neurological deficits and arresting neurological degeneration. However, there is no standardized therapy for LM because of a lack of randomized trials on this condition.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Combined Modality Therapy; Humans; Meningeal Carcinomatosis; Meningeal Neoplasms; Neoplasm Metastasis
PubMed: 30015053
DOI: 10.1016/j.clineuro.2018.07.001 -
Neurosurgery Clinics of North America Oct 2020Leptomeningeal carcinomatosis is a devastating consequence of late-stage cancer, and despite multimodal treatment, remains rapidly fatal. Definitive diagnosis requires... (Review)
Review
Leptomeningeal carcinomatosis is a devastating consequence of late-stage cancer, and despite multimodal treatment, remains rapidly fatal. Definitive diagnosis requires identification of malignant cells in the cerebrospinal fluid (CSF), or frank disease on MRI. Therapy is generally palliative and consists primarily of radiotherapy and/or chemotherapy, which is administered intrathecally or systemically. Immunotherapies and novel experimental therapies have emerged as promising options for decreasing patient morbidity and mortality. In this review, the authors discuss a refined view of the molecular pathophysiology of leptomeningeal carcinomatosis, current approaches to disease management, and emerging therapies.
Topics: Animals; Brain; Disease Models, Animal; Humans; Meningeal Carcinomatosis
PubMed: 32921356
DOI: 10.1016/j.nec.2020.06.010 -
Current Opinion in Oncology Nov 2019Highlight recent data in lung and breast cancer leptomeningeal disease and address clinical trials that are open for patients. (Review)
Review
PURPOSE OF REVIEW
Highlight recent data in lung and breast cancer leptomeningeal disease and address clinical trials that are open for patients.
RECENT FINDINGS
Patients with lung and breast cancer leptomeningeal disease have survival outcomes of less than 1 year, despite advances in treatment strategy. Efforts to develop liquid biopsy biomarkers of disease progression from cerebrospinal fluid and plasma are underway. There are over 10 clinical trials open for patients with leptomeningeal disease, half of which use immunotherapy.
SUMMARY
Consortium-based, multicenter clinical trials for patients with leptomeningeal disease are urgently needed to expand the treatment armamentarium.
Topics: Biomarkers, Tumor; Breast Neoplasms; Clinical Trials as Topic; Female; Humans; Liquid Biopsy; Lung Neoplasms; Meningeal Carcinomatosis
PubMed: 31503030
DOI: 10.1097/CCO.0000000000000574 -
Neuro-oncology Oct 2022
Topics: Diagnostic Imaging; Humans; Meningeal Carcinomatosis
PubMed: 35421226
DOI: 10.1093/neuonc/noac101 -
Current Opinion in Neurology Dec 2016To review recent original data on leptomeningeal metastases in patients with solid cancer. (Review)
Review
PURPOSE OF REVIEW
To review recent original data on leptomeningeal metastases in patients with solid cancer.
RECENT FINDINGS
Lung and breast cancer as well as melanoma remain the most common primaries. Advanced cytological methods and targeted sequencing for candidate tumor-specific mutations may improve the sensitivity of cerebrospinal fluid diagnostics in leptomeningeal metastases. Targeted treatments like epidermal growth factor receptor tyrosine kinase inhibitors for non-small cell lung cancer, anti-human epidermal growth factor receptor-2 treatments for breast cancer or B-rapidly accelerated fibrosarcoma-targeted or immunotherapy for melanoma have an emerging role in the management of this condition.
SUMMARY
Novel diagnostic approaches and the introduction of targeted agents may improve the clinical management of patients with leptomeningeal metastases from solid cancers.
Topics: Antineoplastic Agents; Breast Neoplasms; Carcinoma, Non-Small-Cell Lung; ErbB Receptors; Humans; Immunotherapy; Lung Neoplasms; Melanoma; Meningeal Carcinomatosis; Mutation
PubMed: 27661208
DOI: 10.1097/WCO.0000000000000393 -
Journal of Clinical Neuroscience :... Apr 2015Leptomeningeal metastasis (LM) in breast cancer patients confers a uniformly poor prognosis and decreased quality of life. Treatment options are limited and often... (Review)
Review
Leptomeningeal metastasis (LM) in breast cancer patients confers a uniformly poor prognosis and decreased quality of life. Treatment options are limited and often ineffective, due in large part to limitations imposed by the blood-brain barrier and the very aggressive nature of this disease. The majority of studies investigating the treatment of LM are not specific to site of origin. Conducting randomized, disease-specific clinical trials in LM is challenging, and much clinical outcomes data are based on case reports or retrospective case series. Multiple studies have suggested that chemo-radiotherapy is superior to either chemotherapy or radiation therapy alone. Attempts to overcome current obstacles in the treatment of breast cancer LM hold promise for the future. We review the epidemiology, diagnosis, and prognosis of LM in breast cancer, and discuss the treatment options currently available as well as those under investigation.
Topics: Chemoradiotherapy; Combined Modality Therapy; Humans; Meningeal Carcinomatosis; Meningeal Neoplasms; Prognosis
PubMed: 25677875
DOI: 10.1016/j.jocn.2014.10.022 -
Expert Review of Pharmacoeconomics &... Aug 2018To evaluate the clinical efficacy of meningeal carcinomatosis (MC) treated by intrathecal chemotherapy (IC) and analyzes the prognostic factors.
OBJECTIVE
To evaluate the clinical efficacy of meningeal carcinomatosis (MC) treated by intrathecal chemotherapy (IC) and analyzes the prognostic factors.
METHODS
The clinical and follow-up data of 33 MC patients was collected and retrospectively analyzed. Potential prognostic factors such as age, gender, primary cancer, transfer time, presence of brain metastasis, intracranial pressure, protein, glucose, vascular endothelial growth factor (VEGF), eastern cooperative oncology group (ECOG) performance status (PS), systemic treatment and IC were discussed.
RESULTS
The most common clinical manifestation of MC was high intracranial pressure (30 cases). The negative rate of cerebrospinal fluid cytology was 50% after MC patients treated by IC. The remission rate of IC and no-IC group was 71.4% and 15.7%, respectively, of which the stability rate was 92.8% and 57.8% with significant difference. The median survival time was 5.200 months (95% CI 0.000-11.491) and the survival rate of 3, 6, 12 months were respectively 71.6%, 49.2%, 30.7%.
CONCLUSION
IC can relieve the symptoms of MC and extend life expectancy. Early treatment can improve prognosis. Presence of brain metastasis, ECOG PS and IC were correlated with prognosis of patients, whereas IC is an independent prognostic factor.
Topics: Adult; Aged; Antineoplastic Agents; Brain Neoplasms; Female; Follow-Up Studies; Humans; Injections, Spinal; Intracranial Hypertension; Male; Meningeal Carcinomatosis; Middle Aged; Prognosis; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 29745736
DOI: 10.1080/14737167.2018.1467269 -
Annals of Palliative Medicine Nov 2023As novel systemic therapies allow patients to live longer with cancer, the risk of developing central nervous system (CNS) metastases increases and providers will more... (Review)
Review
BACKGROUND AND OBJECTIVE
As novel systemic therapies allow patients to live longer with cancer, the risk of developing central nervous system (CNS) metastases increases and providers will more frequently encounter emergent presentation of brain metastases (BM) and leptomeningeal metastases (LM). Management of these metastases requires appropriate work-up and well-coordinated multidisciplinary care. We set out to perform a review of emergent radiotherapy (RT) for CNS metastases, specifically focusing on BM and LM.
METHODS
We review the appropriate pathways for workup and initial management of BM and LM, while reviewing the literature supporting emergent treatment of these entities with surgery, systemic anti-cancer therapy, and RT. To inform this narrative review, literature searches in PubMed and Google Scholar were conducted, with preference given to articles employing modern RT techniques, when applicable. Due to the paucity of high-quality evidence for management of BM and LM in the emergent setting, discussion was supplemented by the authors' expert commentary.
KEY CONTENT AND FINDINGS
This work highlights the importance of surgical evaluation, particularly for patients presenting with significant mass effect, hemorrhagic metastases, or increased intracranial pressure. We review the rare situations where emergent initiation of systemic anti-cancer therapy is indicated. When defining the role of RT, we review factors guiding selection of appropriate modality, treatment volume, and dose-fractionation. Generally, 2D- or 3D-conformal treatment techniques prescribed as 30 Gy in 10 fractions or 20 Gy in 5 fractions, should be employed in the emergent setting.
CONCLUSIONS
Patients with BM and LM present from a diverse array of clinical situations, requiring well-coordinated multidisciplinary management, and there is a paucity of high-quality evidence guiding such management decisions. This narrative review aims to more thoroughly prepare providers for the challenging situation of emergent management of BM and LM.
Topics: Humans; Meningeal Carcinomatosis; Brain Neoplasms; Brain
PubMed: 37431225
DOI: 10.21037/apm-22-1276