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- Title
LEPTO MENINGEAL CARCINO MATOSIS : A DIAGNOSTIC AND THERAPEUTIC CHALLENGE.
- Authors
VIDMAR, MARIJA SKOBLAR
- Abstract
In September, The EANO-ESMO guidelines for the diagnosis, treatment, and follow-up of leptomeningeal disease were published. This text is based on those guidelines. Leptomeningeal metastasis (LM) is defined as the spread of tumor cells within the leptomeninges and the subarachnoid space. It typically occurs in approximately 10% of patients with solid cancers, often in the context of progressive systemic disease. The incidence of central nervous system metastasis, including LM, appears to be increasing. This may be attributed to improved patient survival related to the development of new systemic agents that are potentially less effective within the central nervous system than outside it, as well as advancements in diagnostic assessment. Breast cancer, lung cancer, and melanoma are the main primary tumors in patients with LM. The diagnosis of LM is based on clinical evaluation, cerebrospinal magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis. Cerebrospinal MRI, without and with contrast enhancement, is the gold-standard imaging method. The MRI presentation can be divided into five main subtypes: linear leptomeningeal disease (Type A), nodular leptomeningeal disease (Type B), a combination of linear and nodular leptomeningeal disease (Type C), hydrocephalus only (Type D – hydrocephalus), or no neuroimaging evidence of leptomeningeal metastasis (Type D – normal). Lumbar punctures should be performed after neuroimaging to avoid any potential risks to the patients. CSF analysis results are typically categorized as positive (the presence of malignant cells), equivocal (suspicious or atypical cells), or negative (the absence of malignant or potentially malignant cells). The treatment needs to be individualized. It is guided by factors such as the primary tumor, and its systemic treatment options, as well as the clinical, imaging, and cytological presentation of LM. The treatment approach often involves a combination of intrathecal therapy, systemic pharmacotherapy, and focal radiotherapy.
- Subjects
NODULAR disease; MAGNETIC resonance imaging; CENTRAL nervous system; SPINAL infusions; SUBARACHNOID space; CRITICAL success factor
- Publication
Lijecnicki Vjesnik, 2023, Vol 145, p3
- ISSN
0024-3477
- Publication type
Article
- DOI
10.26800/LV-145-supl6-1