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Quantitative Imaging in Medicine and... Feb 2023
PubMed: 36819248
DOI: 10.21037/qims-22-727 -
CNS Drugs Jan 2023Leptomeningeal metastases represent an aggressive stage of cancer with few durable treatment options. Improved understanding of cancer biology, neoplastic reliance on... (Review)
Review
Leptomeningeal metastases represent an aggressive stage of cancer with few durable treatment options. Improved understanding of cancer biology, neoplastic reliance on oncogenic driver mutations, and complex immune system interactions have resulted in an explosion in cancer-directed therapy in the last two decades to include small molecule inhibitors and immune checkpoint inhibitors. Most of these therapeutics are underexplored in patients with leptomeningeal metastases, limiting extrapolation of extracranial and even intracranial efficacy outcomes to the unique leptomeningeal space. Further confounding our interpretation of drug activity in the leptomeninges is an incomplete understanding of drug penetration through the blood-cerebrospinal fluid barrier of the choroid plexus. Nevertheless, a number of retrospective studies and promising prospective trials provide evidence of leptomeningeal activity of several small molecule and immune checkpoint inhibitors and underscore potential areas of further therapeutic development for patients harboring leptomeningeal disease.
Topics: Humans; Retrospective Studies; Immune Checkpoint Inhibitors; Prospective Studies; Meningeal Carcinomatosis; Blood-Brain Barrier
PubMed: 36474108
DOI: 10.1007/s40263-022-00975-5 -
Current Oncology (Toronto, Ont.) Aug 2021Sensorineural hearing loss (SNHL) has been reported rarely in patients with meningeal carcinomatosis (MC). We summarized the clinical data of eight MC patients with SNHL...
Sensorineural hearing loss (SNHL) has been reported rarely in patients with meningeal carcinomatosis (MC). We summarized the clinical data of eight MC patients with SNHL and 35 patients reported from publications. In the eight patients with SNHL, the medium onset age was 48 (range from 37 to 66) years and six (75%) were male. Seven (87.5%) suffered from headaches as the initial symptom, and they experienced SNHL during the first two months after the occurrence of headaches (0.5 to 2 months, average 1.5 months). The audiogram configuration was flat in three patients (37.5%) and showed total deafness in five patients (62.5%). The damage of cranial nerves VI (abducens) was observed in six patients (75%), and four patients (50%) had cranial nerves VII (facial) injury during the disease course. The percentage of damage of cranial nerves was higher than the patients without SNHL (VIth, 75.0% vs. 13.3%, = 0.002 and VIIth 50.0% vs. 6.7%, = 0.012). Four (50%) patients suffered from lung adenocarcinoma as primary tumor, two (25%) experienced stomach adenocarcinoma, one had colon cancer, and one patient was unknown. The symptom of SNHL improved after individualized therapy in four patients (focal radiotherapy and chemotherapy for three patients and whole brain radiotherapy for one patient), but all passed away from 2 to 11 months after diagnosis. Total deafness and flat hearing loss in audiogram were the common types of SNHL resulting from MC. MC patients with SNHL were more likely to suffer from the damage of other cranial nerves, especially to cranial nerves VI and VII. Treatment might improve SNHL, but not improve the case fatality rate.
Topics: Adenocarcinoma; Adult; Aged; Deafness; Disease Progression; Hearing Loss, Sensorineural; Humans; Male; Meningeal Carcinomatosis; Middle Aged
PubMed: 34449589
DOI: 10.3390/curroncol28050281 -
Revista de Neurologia Apr 2017The appearance of meningeal carcinomatosis in breast cancer is an event that is being reported increasingly more frequently in the literature. It seems to be related... (Review)
Review
The appearance of meningeal carcinomatosis in breast cancer is an event that is being reported increasingly more frequently in the literature. It seems to be related with the lengthening of the patients' lives, improved sensitivity to diagnostic imaging and impermeability of the blood-brain barrier to the chemotherapeutic agents. It is an evolutionary form that affirms the metastatic invasion of the subarachnoidal space and is correlated with limited survival. Its diagnosis is difficult, due to the lack of specificity of the clinical signs dominated by headaches, cognitive disorders and possible signs and symptoms of progressive focal lesions. Magnetic resonance imaging of the brain and the spinal cord interpreted by a specialist in neuro-oncology is the preferred examination in this indication, in the search for an increase in meningeal enhancement. Biological analysis of the cerebrospinal fluid is an essential element in the diagnosis. In addition to the biochemical study, the presence of neoplastic cells is in itself enough to confirm the diagnosis. False negatives are very common and represent an important diagnostic problem that entails the need to repeat the lumbar punctures. The therapeutic methods are standard, often invasive, dominated by intrathecal chemotherapy and are based on low-level scientific evidence. This study analyses the epidemiology, the prognostic factors, the diagnostic tools, currently available treatments and the possible future therapies of meningeal carcinomatosis in breast cancer.
Topics: Breast Neoplasms; Female; Humans; Meningeal Carcinomatosis
PubMed: 28345737
DOI: No ID Found -
BMC Neurology Nov 2022Meningeal carcinomatosis is mainly associated with breast cancer, lung cancer, and melanoma. However, meningeal carcinomatosis secondary to a neurenteric cyst with...
BACKGROUND
Meningeal carcinomatosis is mainly associated with breast cancer, lung cancer, and melanoma. However, meningeal carcinomatosis secondary to a neurenteric cyst with malignant features is extremely rare.
CASE PRESENTATION
We report the case of a 35-year-old woman who was admitted to the hospital with a 10-month history of headache, 6-month history of diplopia, 4-month history of hearing loss, and 1-month history of back pain, suggesting a diagnosis of chronic meningitis. Notably, enhanced brain and spinal cord magnetic resonance imaging (MRI) revealed extensive lesions with enhancement signals in the pia mater of the pons and cervical, thoracic, and lumbar spinal cord. The cerebral spinal fluid profile showed that pressure was significantly elevated, with a slight increase in leukocytes that mostly comprised mononuclear cells and decreased glucose concentration. Cytology evaluation showed a small cluster of atypical nuclei, which were suspected to be tumor cells arising from the epithelium. However, no primary tumor was found through comprehensive body and skin screening. After a histopathological biopsy of subarachnoid meninx of the thoracic spinal canal, the cause of meningeal carcinomatosis of this patient was determined as neurenteric cysts with malignant features, which is extremely rare.
CONCLUSION
This is the first case to ever report neurenteric cysts as a cause of leptomeningeal carcinomatosis and the first ever report of neurenteric cysts presenting as leptomeningeal carcinomatosis without typical cyst visible on brain MRI. This extremely rare case provided a novel view on the pathogenesis of meningeal carcinomatosis and clinical presentation of neurenteric cysts, highlighting the value of meningeal biopsy in chronic meningitis of unknown causes.
Topics: Female; Humans; Adult; Meningeal Carcinomatosis; Neural Tube Defects; Cell Transformation, Neoplastic; Magnetic Resonance Imaging; Spinal Cord Diseases; Meningitis
PubMed: 36384561
DOI: 10.1186/s12883-022-02978-7 -
Neuro-oncology Feb 2023
Topics: Humans; Female; Trastuzumab; Breast Neoplasms; Meningeal Carcinomatosis; Methotrexate
PubMed: 36534954
DOI: 10.1093/neuonc/noac225 -
Thoracic Cancer Aug 2022With the development of imaging, the etiology of ocular lesions caused by lung cancer was not found only intraocular. Neuro-ophthalmological imaging has been found to be...
BACKGROUND
With the development of imaging, the etiology of ocular lesions caused by lung cancer was not found only intraocular. Neuro-ophthalmological imaging has been found to be useful for the diagnosis of meningeal carcinomatosis, although few studies have previously been published. Our study used magnetic resonance imaging (MRI) to determine if there was a the relationship between ocular symptoms and lung cancer metastasis.
METHODS
We carried out a retrospective analysis which included patients with ocular lesions and lung cancer on which orbit MRI was performed together with ocular examination during January 2014 to January 2022. Here, we describe the characteristics of intraocular metastasis and optic nerve sheath lesions.
RESULTS
A total of 21 lung cancer patients had ocular lesions, of which eight cases had choroidal metastasis; a further eight patients had optic nerve sheath lesions. There was one case (12.5%) of choroidal metastasis with brain or meningeal metastasis, and eight cases (100%) with optic nerve sheath lesions with brain or meningeal metastasis. A total of 75.0% patients with choroidal metastasis did not have any history of known lung cancer, and 25.0% of optic nerve sheath lesions in patients were found before a meningeal metastasis diagnosis. The features of optic nerve sheath lesions included thickening and strengthening of the long segment of the orbital optic nerve sheath with a clear boundary.
CONCLUSIONS
The pathway of choroidal and optic nerve sheath lesions was different. Optic nerve sheath lesions were associated with brain and meningeal metastasis. When lung cancer-induced meningeal metastasis is suspected, orbital MRI is recommended to assist in the diagnosis.
Topics: Brain; Humans; Lung; Lung Neoplasms; Meningeal Carcinomatosis; Optic Nerve; Retrospective Studies
PubMed: 35702825
DOI: 10.1111/1759-7714.14538 -
Cancer Jan 2018Leptomeningeal metastasis is an uncommon and typically late complication of cancer with a poor prognosis and limited treatment options. Diagnosis is often challenging,... (Review)
Review
Leptomeningeal metastasis is an uncommon and typically late complication of cancer with a poor prognosis and limited treatment options. Diagnosis is often challenging, with nonspecific presenting symptoms ranging from headache and confusion to focal neurologic deficits, such as cranial nerve palsies. Standard diagnostic evaluation involves a neurologic examination, magnetic resonance imaging of the brain and spine with gadolinium, and cytologic evaluation of the cerebral spinal fluid. Therapy entails a multimodal approach focused on palliation with surgery, radiation, and/or chemotherapy, which may be administered systemically or directly into the cerebral spinal fluid. Limited trial data exist to guide treatment, and current regimens are based primarily on expert opinion. Although newer targeted and immunotherapeutic agents are under investigation and have shown promise, an improved understanding of the biology of leptomeningeal metastasis and treatment resistance as well as additional randomized controlled studies are needed to guide the optimal treatment of this devastating disease. Cancer 2018;124:21-35. © 2017 American Cancer Society.
Topics: Antineoplastic Agents; Antineoplastic Agents, Immunological; Cerebrospinal Fluid; Combined Modality Therapy; Contrast Media; Disease Management; Gadolinium; Humans; Injections, Spinal; Magnetic Resonance Imaging; Meningeal Carcinomatosis; Meningeal Neoplasms; Neurosurgical Procedures; Radiotherapy
PubMed: 29165794
DOI: 10.1002/cncr.30911 -
Deutsches Arzteblatt International Mar 2023Metastases are the most common malignant tumors affecting the central nervous system and occur in 20-40 percent of patients with solid systemic tumors. The aim of this... (Review)
Review
BACKGROUND
Metastases are the most common malignant tumors affecting the central nervous system and occur in 20-40 percent of patients with solid systemic tumors. The aim of this review is to discuss the role of neurosurgical procedures in a modern, multidisciplinary treatment approach.
METHODS
An expert panel of neurosurgeons, neurologists, and radio-oncologists conducted a selective literature review on neu - rosurgical interventions for the diagnosis and treatment of cerebral metastases. Original articles, meta-analyses, and systematic reviews were included.
RESULTS
There is a lack of prospective randomized studies. Based on retrospective case series, international guidelines recommend the harvesting (if required, stereotactically guided) of tissue for histological and molecular diagnosis in cases of unknown or possibly competing underlying systemic malignant diseases, in cases of suspected tumor recurrence, and with regard to the evaluation of targeted therapies taking into account molecular heterogeneity of primary and secondary tumors. Surgical resection is particularly valuable for the treatment of up to three space-occupying cerebral metastases, especially to achieve clinical stabilization to allow further non-surgical treatment. For cystic metastasis, a combination of stereotactic puncture and radiotherapy may be useful. Meningeal carcinomatosis can be treated with intrathecal medication via an intraventricular catheter system. Ventriculo-peritoneal shunts represents an effective treatment option for patients with tumor-associated hydrocephalus.
CONCLUSION
Neurosurgical procedures are of central importance in the multimodal treatment of cerebral metastases. The indications for neurosurgical interventions will be refined in the light of more effective radiation techniques and systemic treatments with new targeted therapeutic approaches and immunotherapies on the horizon.
Topics: Humans; Brain Neoplasms; Retrospective Studies; Neoplasm Recurrence, Local; Treatment Outcome; Neurosurgical Procedures
PubMed: 36650742
DOI: 10.3238/arztebl.m2022.0410 -
BMC Cancer Dec 2015The incidence of meningeal carcinomatosis appears to be higher than in the past due to advances in neuro-imaging diagnostic techniques and improvements in cancer...
BACKGROUND
The incidence of meningeal carcinomatosis appears to be higher than in the past due to advances in neuro-imaging diagnostic techniques and improvements in cancer survival. Among solid tumors, breast cancer is the cancer most commonly associated with meningeal carcinomatosis, with an incidence rate of between 0.8 and 16%. Aim of this study has been i) to evaluate the incidence of meningeal carcinomatosis in a continuous breast cancer unselected series treated in a dedicated Breast Unit and ii) to define the clinico-pathological and molecular parameters associated with meningeal carcinomatosis development.
METHODS
A retrospective series of 1915 consecutive patients surgically treated for breast cancer between 1998 and 2010 was collected. Clinico-pathological data were recorded from medical charts and pathological reports, including the date of development of symptomatic meningeal carcinomatosis. Meningeal carcinomatosis incidence was determined at both 5- and 10-year follow-ups.
RESULTS
Three patients in the first 5 years of follow-up and six patients in 10 years of follow-up developed meningeal carcinomatosis. An incidence rate of 5.44 per 10,000 patients (95% CI: 1.75-16.9) was observed, with a 5-year risk of 0.3%. At 10-year follow up, the rate increased to 7.55 per 10,000 patients (95% CI: 3.39-16.8). In a univariate analysis, young age, tumor size larger than 15 mm, histological grade 3, more than three metastatic lymph nodes, negative estrogen receptor, positive HER2 and high proliferative index were significantly associated with meningeal carcinomatosis development.
CONCLUSIONS
In an unselected breast cancer population, meningeal carcinomatosis is a rare event that is associated with adverse prognostic factors. Meningeal carcinomatosis incidence is overestimated when recorded in biased/high-risk selected breast cancer patients and should not be considered to accurately reflect the overall breast cancer population.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Incidence; Meningeal Carcinomatosis; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Young Adult
PubMed: 26715407
DOI: 10.1186/s12885-015-2042-y