A combination of surgery, radiation, and chemotherapy treatment improves the prognosis for leptomeningeal disease. Some tumor types are especially sensitive to chemotherapy injected directly into the cerebrospinal fluid, either by lumbar puncture (“spinal tap”) or through a surgically implanted device called an Ommaya.
Full Answer
How is leptomeningeal disease treated?
· The goal of treatment of leptomeningeal metastasis is to improve survival and to maintain quality of life by delaying neurological deterioration. Tumour-specific therapeutic options include intrathecal pharmacotherapy, systemic pharmacotherapy and focal radiotherapy. Recently, improvement of leptomeningeal disease–related progression-free ...
Which medications are used in the treatment of leptomeningeal metastasis?
Recently, improvement of leptomeningeal disease-related progression-free survival by adding intrathecal liposomal cytarabine to systemic treatment versus systemic treatment alone has been observed in a randomised phase III trial for patients with breast cancer with newly diagnosed leptomeningeal metastasis.
What is leptomeningeal disease and how common is it?
Methods. To explore the feasibility of the Leptomeningeal Assessment in Neuro-Oncology (LANO) scorecard, cerebrospinal MRIs of 22 patients with LM from solid tumors were scored by 10 neuro-oncologists and 9 neuroradiologists at baseline and at follow-up after treatment. Raters were blinded for clinical data including treatment. Agreement between raters of single items was …
What tests are used to diagnose leptomeningeal disease?
Leptomeningeal disease cannot be cured. Moreover, it is difficult to treat. The main objective of treatment includes stabilizing the patient’s neurological status and prolonging their survival and palliation. Sometimes, combinations of treatments are needed, such as radiation, surgery, and/or chemotherapy. Standard therapies include:
How long can you live with leptomeningeal metastases?
Leptomeningeal metastases from solid tumors confer a poor overall prognosis. Mean survival from the time of diagnosis is 2 to 4 months. However, subsets of patients, specifically those with lymphoma and breast cancer, may survive for more than 1 year with a reasonably good quality of life.
How do you treat patients with leptomeningeal metastases?
Treatment of leptomeningeal metastases (LM) is individualized based on factors including histology, prognosis, presence of bulky CNS disease, and the state of systemic disease. Treatment modalities may include systemic chemotherapy, radiation therapy, use of targeted agents, intrathecal therapy, and immunotherapy.
Can you survive leptomeningeal disease?
Prognosis remains grim in patients with LC. The time from diagnosis to death is about 4 to 6 weeks if left untreated. With treatment, overall survival is approximately 2 to 4 months.
What is the survival rate for leptomeningeal disease?
Despite advances in targeted radiation and chemotherapy, survival remains poor after diagnosis of leptomeningeal involvement, averaging 3–6 months. Survival varies by etiology, with breast cancer patients having the best prognosis (13–25% survival at one year and 6% at two years) [1, 4, 5].
Is there a cure for Leptomeningeal disease?
While there's no cure for leptomeningeal disease yet, radiation and chemotherapy are the two most common treatments. Since it's very hard for drugs to make it into the central nervous system, the chemotherapy is delivered intrathecally.
How fast does Leptomeningeal disease progress?
Reported outcomes of LM from solid tumors have indicated high rates of progression to death within 4 to 6 weeks without therapy [7].
What does leptomeningeal feel like?
Leptomeningeal disease may also be referred to as carcinomatous meningitis or neoplastic meningitis. Most often with this complication, people have multiple neurological symptoms including visual changes, speech problems, weakness or numbness of one side of the body, loss of balance, confusion, or seizures.
How do you get leptomeningeal disease?
Leptomeningeal disease (also known as LMD, leptomeningeal metastases, or LM) is cancer in your cerebrospinal fluid and in your leptomeninges, the membranes that surround your brain and spinal cord. It happens when an advanced cancer spreads from part of your body to your cerebrospinal fluid and leptomeninges.
Can leptomeningeal be misdiagnosed?
Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics.
What is leptomeningeal enhancement?
Leptomeningeal enhancement is usually associated with meningitis, which may be bacterial, viral, or fungal. The primary mechanism of this enhancement is breakdown of the blood-brain barrier without angiogenesis.
What is leptomeningeal involvement?
Leptomeningeal metastases mean cancer cells have spread to the thin layers of tissue that cover the brain and spinal cord (the leptomeninges). It is also called: carcinomatosis meningitis.
What is intrathecal chemotherapy?
Listen to pronunciation. (IN-truh-THEE-kul KEE-moh-THAYR-uh-pee) Treatment in which anticancer drugs are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord.
What does leptomeningeal feel like?
The most common problems are headaches, nausea, vomiting, double vision, weakness, loss of urine control, and difficulty walking, but leptomeningeal disease can cause almost any neurological problem, depending on where the cancer cells land.
How is leptomeningeal metastases diagnosed?
Imaging. Magnetic resonance imaging (MRI) of the brain and spine, with and without contrast, is the gold standard in diagnosing leptomeningeal disease. Sometimes the disease occurs only in the spine and not the brain, and therefore a scan of the full spine and brain is recommended.
How do you get leptomeningeal disease?
Leptomeningeal disease (also known as LMD, leptomeningeal metastases, or LM) is cancer in your cerebrospinal fluid and in your leptomeninges, the membranes that surround your brain and spinal cord. It happens when an advanced cancer spreads from part of your body to your cerebrospinal fluid and leptomeninges.
Can leptomeningeal be misdiagnosed?
Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics.
What is the treatment for leptomeningeal metastasis?
Tumour-specific therapeutic options include intrathecal pharmacotherapy, systemic pharmacotherapy and focal radiotherapy.
Does systemic therapy help with brain metastasis?
Systemic therapy using targeted agents and immunotherapy has also improved outcome in patients with brain metastasis, and its emerging role in the management of leptomeningeal metastasis needs to better studied in prospective series.
How does chemotherapy help with leptomeningeal disease?
A combination of surgery, radiation, and chemotherapy treatment improves the prognosis for leptomeningeal disease. Some tumor types are especially sensitive to chemotherapy injected directly into the cerebrospinal fluid, either by lumbar puncture (“spinal tap”) or through a surgically implanted device called an Ommaya.
Why is leptomeningeal disease so difficult to detect?
It can be difficult to detect leptomeningeal disease because magnetic resonance imaging cannot always pick up the problem.
Can leptomeningeal cancer cause headaches?
The most common problems are headaches, nausea, vomiting, double vision, weakness, loss of urine control, and difficulty walking, but leptomeningeal disease can cause almost any neurological problem, depending on where the cancer cells land.
Why is leptomeningeal disease so challenging?
Diagnosing leptomeningeal disease can be challenging, not only because of the overlap of symptoms with those of brain metastases, but because of the testing process. A high index of suspicion is necessary to ensure that the appropriate tests are run for a timely diagnosis.
Why is leptomeningeal disease so difficult to diagnose?
Diagnosis. Diagnosing leptomeningeal disease can be challenging, not only because of the overlap of symptoms with those of brain metastases, but because of the testing process. A high index of suspicion is necessary to ensure that the appropriate tests are run for a timely diagnosis.
Why are leptomeningeal metastases so difficult to treat?
Leptomeningeal metastases are challenging to treat for several reasons. One is that they often occur in advanced stages of cancer and after a person has been ill for a significant period. For this reason, people with the disease may be less able to tolerate treatments such as chemotherapy.
How long do you live with leptomeningeal metastases?
In general, the prognosis of leptomeningeal metastases is poor, with life expectancy often measured in months or weeks. That said, some people who are otherwise in reasonable health and can tolerate treatments do very well. This number of longer-term survivors living with leptomeningeal disease is expected to grow now that newer treatments that can penetrate the blood-brain barrier are available.
What cancers can be found in leptomeninges?
The most common cancers to spread to the leptomeninges are breast cancer, lung cancer (both non-small cell and small cell), and melanoma. Other cancers where these metastases sometimes develop include digestive tract, renal cell (kidney), and thyroid, and some leukemias and lymphomas.
What is the treatment for spinal cancer?
Diagnosis is usually made with a combination of an MRI and spinal tap. Treatments may include radiation and/or chemotherapy directly into the spinal fluid (intrathecal chemotherapy), along with systemic treatments for the particular cancer being treated. Verywell / Emily Roberts.
Can MRI show leptomeningeal disease?
Magnetic resonance imaging (MRI) of the brain and spine, with and without contrast, is the gold standard in diagnosing leptomeningeal disease. Sometimes the disease occurs only in the spine and not the brain, and therefore a scan of the full spine and brain is recommended. On an MRI, radiologists can see inflamed meninges and any co-existing brain metastases.
What is the leptomeningeal?
Leptomeningeal actually consists of the arachnoid and pia matter, and between the spaces is the CSF. Tumor cells may enter this space with the flow of cerebrospinal fluid, or CSF, and get transported throughout the entire nervous system. This results in multifocal seeding or diffuse infiltration of the leptomeningeal.
How long does it take to recover from leptomeningeal metastases?
With treatment, the patient’s survival can extend up to six to ten months.
What is the name of the tumor that is seeded by the leptomeningeal?
Leptomeningeal carcinomatosis is the multifocal seeding of the leptomeningeal by the tumor cells if the primary cells are solid tumor cells. If the primary cells are not solid tumor, it is known as leukemic meningitis. Leukemic meningitis is also known as lymphomatous meningitis.
Where does leptomeningeal carcinoma spread?
Leptomeningeal carcinomatosis spreads to the surrounding membrane of the brain and spinal cord. The neoplastic cells in the subarachnoid space invade and proliferate.
Is leptomeningeal carcinoma a complication?
Leptomeningeal carcinomatosis is a serious complication of cancer. It is also known as neoplastic meningitis. It causes substantial morbidity and mortality. It can occur at any time. Leptomeningeal disease is mostly associated with a relapse of cancer elsewhere in the body. In the neoplastic disease, leptomeningeal carcinomatosis can occur ...
What is the best treatment for melanoma?
Vemurafenib and dabrafenib are two types of targeted cancer drugs which have helped some people with certain types of melanoma skin cancer and non small cell lung cancer (NSCLC) with leptomeningeal metastases. Bevacizumab (Avastin) can sometimes help people with lung cancer that have leptomeningeal metastases.
Can leptomeningeal metastases be treated?
There are no set guidelines for treating leptomeningeal metastases because doctors are still looking at which treatments work best at entering the cerebrospinal fluid (CSF), how well they work at treating the cancer and their side effects. The CSF is a clear fluid that surrounds the brain and spinal cord.
How to treat leptomeningeal disease?
The most common approach to treat LMD is to use surgery, radiation, or chemotherapy. One method is to inject chemotherapy directly into ...
How to treat LMD?
The most common approach to treat LMD is to use surgery, radiation, or chemotherapy. One method is to inject chemotherapy directly into the spinal fluid by lumbar puncture (spinal tap) or by implanting a device called an Ommaya .
What is LMD in medical terms?
What is Leptomeningeal Disease and how is it treated? Leptomeningeal disease (LMD) occurs when cancer cells migrate from the breast, lung, or other parts of the body to the cerebrospinal fluid (CSF) or meninges.
Abstract
Leptomeningeal metastasis (LM) is a devastating complication of cancer with variable clinical presentation and limited benefit from existing treatment options. In this review, we discuss advances in LM diagnostics and therapeutics with the potential to reverse this grim course.
Diagnostic Advances in Leptomeningeal Metastasis
Classically, LM is diagnosed on the basis of magnetic resonance imaging (MRI) and CSF cytology. Cranial LM involvement can be identified on MRI as contrast enhancement along cranial nerves and the leptomeninges, particularly in the cerebellar folia ( Figure 1 ).
Therapeutic Advances in Leptomeningeal Disease
Current clinical practice is dominated by the poor outcome of LM. The primary goals are therefore symptomatic management by surgical and/or radiation-based therapies followed by intrathecal and/or systemic chemotherapy ( Table 2 ).
Future Perspective
Recent advances in detection, quantification, and targeting of cancer cells within the spinal fluid have the potential to revolutionize the study and management of LM.
Acknowledgments
This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748 and 1R01CA245499-01A1. We are deeply grateful to our patients who continue to inspire us with their generosity and grace in the face of an uncertain future.
Funding
This work was supported by National Institute of Health/National Cancer Institute P30 CA008748 and 1R01CA245499-01A1 to A.B.
Conflict of Interest
Adrienne Boire reports: Evren Technologies (scientific advisory board - unpaid), Patents (inventor) via Sloan Kettering Institute. Ugur Sener has nothing to disclose.
What are the symptoms of LM?
LM can cause many different symptoms, such as: 1 Headaches 2 Nausea (feeling like you’re going to throw up) or vomiting (throwing up) 3 Difficulty thinking 4 Double vision 5 Dizziness 6 Difficulty speaking or swallowing 7 Pain in your arms and legs 8 Weakness or lack of coordination in your arms and legs 9 Loss of bladder or bowel control 10 Seizures
How often do you have a physical exam for LM?
You may have MRI scans, lumbar punctures, or both every 6 to 12 weeks. You may also have a physical exam in clinic every 6 to 12 weeks.