Useful tests to establish diagnosis and guide treatment include. Neoplastic meningitis chamberlain 2009 cancer wiley. Neoplastic meningitis is more likely to occur in patients with disseminated cancer, but in, respectively, 20% and 10% of cases it may manifest after a disease free period or as a first manifestation of systemic tumors 2. We report 3 patients with nm, who were misdiagnosed with infectious meningitis in emergency department ed. Neoplastic meningitis an overview sciencedirect topics. Neoplastic meningitis is mostly seen in patients with breast cancer, lung cancer, and melanoma. Neoplastic meningitis is a complication of the cns that occurs in 35% of patients with cancer and is characterised by multifocal neurological signs and symptoms. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. N2 improved treatment of systemic cancers has prolonged the lives of many patients but has also led to increased incidence of neoplastic meningitis. Treatment of intracerebral neoplasia and neoplastic. Treatment often includes direct installation of chemotherapy into.
Clinical presentation, diagnosis, and radiological. Management of neoplastic meningitis roth chinese clinical. Controlled clinical trials are largely lacking which results in various nonstandardized treatment regimens. Pdf neoplastic meningitis nm is a devastating complication of solid tumors with poor outcome. Diagnosis contrastenhanced magnetic resonance imaging mri is the best method to diagnose malignant cns involvement. Phase i trial of intrathecal liposomal cytarabine in children with neoplastic meningitis. Phase i trial of intrathecal liposomal cytarabine in children with neoplastic meningitis l. Based on the origin of the primary tumor, the condition may be categorized as carcinomatous, lymphomatous, or leukemic meningitis. Neoplastic meningitis the development of meningitis due to the infiltration of the subarachnoid space with cancer cells. These data indicate that cerebrospinal fluid flow abnormalities are common in patients with neoplastic meningitis and that 111indtpa cerebrospinal fluid flow imaging is useful in characterizing. Some randomized clinical trials have been conducted. Individuals with encephalitis often show mild flulike symptoms.
Diagnosis is achieved by recognition of the clinical manifestations of neoplastic meningitis followed by neuroradiography of the brain and spinal cord and examination of the cerebrospinal fluid. Between 1996 and 2009, cerebrospinal fluid samples of 204 adult patients were examined during pretransplant workup for cell counts and, if abnormal, morphologically. For full access to this pdf, sign in to an existing account, or purchase. Brain metastases and neoplastic meningitis clinical gate. Cm, and hematological malignancies leukemic or lymphomatous meningitis. We analyzed the frequency of neoplastic meningitis in patients with acute myeloid leukemia prior to allogeneic hematopoietic stem cell transplantation at our institution. Any kind of neoplasia, including leukemia and lymphoma carcinomatous meningitis due to a carcinoma solid tumors, doesnt include leukemia and lymphoma leptomeningeal metastases lm. Six patients with neoplastic melanomatous meningitis were studied. Neoplastic meningitis treatments are considered palliative, with an emphasis on limiting symptoms such as neurologic deterioration and extending quality of life.
Neoplastic meningitis is due to dissemination of malignant cells to the. Fifteen patients with neoplastic meningitis received a single intrathecal injection of between 11 and 60 mci of a 1i radiolabelled monoclonal antibody moab, chosen for its immunoreactivity to. A 68yearold man visited our ed with a 3month history of headache. Basically, neoplastic meningitis may affect all patients with a malignant tumor but is most common in patients affected by lung cancer, breast carcinoma, melanoma or hematologic neoplasms such. Neoplastic meningitis due to lung, breast, and melanoma. Median progression free and overall survival was 14 and 31 weeks, respectively. Neoplastic meningitis is usually a sign of advanced disease with systemic spread, and therefore has a very poor prognosis.
Neoplastic meningitis needs to remain in the differential diagnosis of any cancer patient with new, particularly multifocal, neurologic symptoms. Diffuse leptomeningeal infiltration by neoplastic cells is a wellrecognized manifestation of malignant tumors. Leptomeningeal cancer also called leptomeningeal carcinomatosis, leptomeningeal disease lmd, leptomeningeal metastasis, neoplastic meningitis, meningeal metastasis and meningeal carcinomatosis is a rare complication of cancer in which the disease spreads from the original tumor site to the meninges surrounding the brain and spinal cord, this leads to an inflammatory response, hence the. Three cases of neoplastic meningitis initially diagnosed with. Neoplastic involvement of cerebrospinal fluid csf secondary to known or unknown primaries elsewhere is a poor prognostic factor and is equivalent to stage iv disease. Treatment is based on the intrathecal administration of chemotherapeutic agents, cranial or craniospinal radiotherapy, and systemic chemotherapy. Recently, the leptomeningeal assessment in neurooncology lano group and the european society for medical oncologyeuropean association. Basically, neoplastic meningitis may affect all patients with a malignant tumor but is most common in patients affected by lung cancer, breast carcinoma, melanoma or hematologic neoplasms such as lymphoma and leukemia. Diagnosis and treatment of leptomeningeal metastases from solid tumors. Recently, the leptomeningeal assessment in neurooncology lano group and the european society for medical oncologyeuropean association for neuro.
We analyzed 56 patients treated initially with surgery and or radio surgery, with or without chemotherapy without wbi from july 2007 to may 2014, with a minimum followup of 4 months. Neoplastic meningitis nm is a common problem in neuro. This retrospective comparison evaluated survival in 2 well. It affects approximately 5% of all patients with cancer. Immunotherapy with cpga odn in neoplastic meningitis. Neoplastic meningitis nm is a devastating complication of solid tumors with poor outcome. Read neoplastic meningitis from systemic malignancies. Neoplastic meningitis nm is a frequent complication of systemic cancer, reported to occur in approximately 5% of all patients with cancer. Neoplastic meningitis is a disease of the entire neuraxis and is pleomorphic in its clinical presentation. I would like to submit a letter to the editor regarding the article multiple myeloma invasion of the central nervous system, which recently appeared in the a rchives schluterman et al 1 retrospectively described 23 patients with multiple myeloma mm and neoplastic meningitis nm from the university of arkansas for medical sciences, a nationally recognized center of excellence for the.
The frequency of neoplastic meningitis is increasing because of heightened clinical suspicion, improved neuroimaging techniques, and longer survival in patients with extraneural cancer longer survival allows residual tumor cells within central nervous. Neoplastic meningitis is a common problem in neurooncology, diagnosed in approximately 5% of all patients with cancer. The terms neoplastic meningitis and carcinomatous meningitis refer to the dissemination of cancer cells within the leptomeningeal space. Neoplastic meningitis nm is a debilitating complication of cancer that occurs when tumour cells infiltrate the leptomeninges. Neoplastic meningitis from breast cancer has a dismal prognosis and short survival. Distinctive rashes are typically seen in some forms of the disease. Nm is a frequent complication of systemic cancer and occurs in 4%15% of all patients with solid tumors. Nm is not infrequent, and is becoming more common as cancer patients live longer. Neoplastic meningitis nm is a common problem in neurooncology. Neoplastic meningitis due to lung, breast, and melanoma metastases emilie le rhun, md, sophie taillibert, md, and marc c. Nm results in significant morbidity, and the median survival duration is short despite therapy. Commentary regarding neoplastic meningitis secondary to.
Although csf cytology and mri are standard methods to diagnose neoplastic meningitis nm, this complication of neoplastic disease remains difficult to detect. Apart from symptomatic treatment, intrathecal chemotherapy is used, with both free. Clinical presentation, diagnosis, and radiological findings of. Clinicoradiological features, outcome and prognostic factors. Treatment of neoplastic meningitis with intrathecal. Leptomeningeal dissemination neoplastic meningitis can occur in patients without known brain parenchymal metastases. The inability to produce therapeutic drug levels intrathecally it with systemic administration and the minimal efficacy of chemotherapeutic agents currently available for direct it use limit therapy.
Neoplastic meningitis in patients with acute myeloid. A clear indication for intensive hospice and palliative care. Longterm survival is occasionally observed in patients with neoplastic meningitis nm accompanying breast cancer % oneyear and 6% 2year survival, melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months. The primary objectives of this trial were to perform a limited dose escalation of it liposomal cytarabine to define a safe dose for use in future clinical studies and to evaluate the csf. Characterize the risk of neoplastic meningitis nm in patients with brain metastasis from nsclc. Benefit of ventriculoperitoneal cerebrospinal fluid.
Neoplastic meningitis is an increasingly recognized complication of advanced metastatic cancer and, if left undiagnosed or untreated, is characterized by rapid neurologic deterioration and death. Diagnosis, prognosis and treatment, seminars in oncology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. In nearly 75% of patients with nm, evidence of progressive systemic cancer is apparent. Prognosis and treatment patients with breast cancer or hematological. A randomized controlled trial comparing intrathecal sustainedrelease cytarabine depocyt to intrathecal methotrexate in patients. Neoplastic meningitis nm is a common problem in neurooncology occurring in approximately 5% of all patients with cancer and is the third most common site of central nervous system metastases. The prognosis for patients who develop neoplastic meningitis or leptomeningeal dissemination of cancer cells remains poor. Neoplastic meningitis neurological surgery long island ny. Neoplastic meningitis refers to infiltration of the meninges by tumor cells. Intrathecal administration of y27632, a specific rho. Nspc is at the forefront of advanced brain cancer treatments and participates in clinical trials to help in the search for cures to these lifechanging. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells.
Neoplastic meningitis is an increasingly frequently occurring devastating complication of both primary cns and extraneural malignancies. Any kind of neoplasia, including leukemia and lymphoma. Apr 20, 2009 neoplastic meningitis nm is a frequent complication of systemic cancer, reported to occur in approximately 5% of all patients with cancer. This chapter discusses the epidemiology, pathogenesis, clinical features, diagnosis, prognosis, and treatment of neoplastic meningitis. Interdisciplinary management of central nervous system. Interdisciplinary management of central nervous system metastasis and neoplastic meningitis.
Neoplastic meningitis nm is diagnosed by the presence of malignant cells in the cerebrospinal fluid csf. Meningitis often appears with flulike symptoms that develop over 12 days. Neoplastic meningitis definition of neoplastic meningitis. Neoplastic meningitis chamberlain 2008 the oncologist. May 01, 20 neoplastic meningitis needs to remain in the differential diagnosis of any cancer patient with new, particularly multifocal, neurologic symptoms. Neoplastic meningitis, a central nervous system cns complication of cancer metastatic to. How to recognize and treat neoplastic meningitis ncbi. Diagnosis and individualized therapy of neoplastic meningitis.
The aim of the study is to analyse the cytological features of neoplastic meningitis in a tertiary care center. The diagnosis of neoplastic meningitis is straightforward in the majority of cases, but a number of cases may pose diagnostic challenges. Results in vitro chemotaxis and invasion assay as shown in fig. For the contribution history and old versions of the redirected page, please see.
Treatment of nm aims to improve neurological symptoms and extend overall. Serial cytologic analysis during treatment can be used to assess response to therapy. Neoplastic meningitis seattle cancer care alliance. Neoplastic meningitis presenting with ophthalmoplegia, ataxia. Neoplastic meningitis presenting with ophthalmoplegia. A randomized controlled trial comparing intrathecal sustainedrelease cytarabine depocyt to intrathecal methotrexate in patients with neoplastic meningitis from solid tumors. Neoplastic meningitis, current treatment options in.
Benefit of ventriculoperitoneal cerebrospinal fluid shunting and intrathecal chemotherapy in neoplastic meningitis. Neoplastic meningitis nm results from leptomeningeal dissemination of cancers arising within the central nervous system or metastasizing to the leptomeninges from systemic neoplasms. Phase i trial of intrathecal liposomal cytarabine in. Brain metastases and neoplastic meningitis sciencedirect. Capecitabine has shown longlasting responses in nm in small case series, 105 and the use of an intensified regimen, such as metronomic schedule, has been proposed to treat nm from breast cancer, and is planned to be investigated in a larger phase ii trial. In this report we describe the case of a woman with neoplastic meningitis from breast carcinoma who developed an excellent response to letrozole combined with. Neoplastic meningitis is an event in the course of cancer with a variable clinical presentation and. Important infective causes include partially treated bacterial pyogenic. The diagnosis of this complication of malignant disease rests on the demonstration of malignant cells within the csf. Clinical presentation, diagnosis, and radiological findings. The diagnosis of neoplastic meningitis is based on clinical signs and symptoms, laboratory.
Phase i trial of intrathecal liposomal cytarabine in children. However, treatment can result in significant palliation of the cns and is best. Prolonged survival of neoplastic meningitis from breast. The addition of monoclonal antibody immunocytology to conventional techniques significantly improved the diagnostic sensitivity of csf cytology, allowing for earlier and therefore more effective palliative. Neoplastic meningitis journal of clinical oncology asco journals.
Leptomeningeal dissemination of tumor cells, also referred to as neoplastic meningitis, is most frequently seen in patients with latestage cancer and mostly associated with a poor prognosis. Thus, the diagnosis and treatment of neoplastic meningitis present challenges for the clinical oncologist. In a study of leptomen ingeal metastases from breast cancer and a study of neoplastic meningitis due to several different primary tumors, researchers found that the median karnofsky performance status was approximately 70%. Sep 21, 2016 purpose we performed a phase i trial of intrathecal it liposomal cytarabine depocyt. Notwithstanding frequent focal signs and symptoms, nm is a disease that affects the entire neuraxis. It has been reported in all kinds of tumor including solid tumors carcinomatous meningitis. Some clinical features are secondary to elevated intracranial pressure and include headaches, papilledema, and altered mental. A retrospective study of 400 consecutive csf samples was done in the.
The term is a misnomer because the condition is not inflammatory. Neoplastic meningitis may present in a variety of ways. Notwithstanding frequent focal signs and symptoms, nm is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid csf compartments. The most frequent primary tumor types that give rise to brain metastases include lung cancer, melanoma, breast cancer, and renal cell carcinoma.
These effects were comparable to those induced by two other actin target reagents. Meningococcal meningitis may be associated with kidney and adrenal gland failure and shock. The term neoplastic meningitis nm, also known as leptomeningeal. Neoplastic meningitis nm is a common problem in neurooncology occurring in.
Background neoplastic meningitis nm also known as leptomeningeal metastases. Secondary endpoints were progression free survival pfs and overall survival os. An association with the immunoglobulin superfamily molecule cd155 renders breast cancer a likely target for oncolytic pv recombinants. Neoplastic meningitis is a diffuse dissemination of tumor cells into the cerebrospinal fluid csf andor leptomeninges. Chronic meningitis is defined as the persistence of clinical symptoms and signs of meningitis, with or without abnormal cerebrospinal fluid, for more than four weeks. In the remainder, infective, neoplastic and socalled aseptic disorders may be identified. The usual clinical presentation is subacute or chronic meningitis with multifocal cranial and spinal nerve root symptoms and a variable degree of. This assumption was confirmed in xenotransplantation models for neoplastic meningitis or solitary cerebral metastasis, where local virus treatment dramatically improved survival.
Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Some randomized clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic parameters, response evaluation and primary endpoints. In as many as one third of cases, no cause is found. Nm is not infrequent and is becoming more common as cancer patients live longer 15. It occurs in approximately 510% of malignant diseases, most often in. Targeted therapy for glioblastoma multiforme neoplastic meningitis with intrathecal delivery of an oncolytic recombinant poliovirus.
It can also present after a disease free interval or even be the first manifestation of a malignancy. Chronic and recurrent meningitis practical neurology. The usual clinical presentation is subacute or chronic meningitis with multifocal cranial and spinal nerve root symptoms and a variable degree of encephalopathy. Some randomized clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic par. Guidelines for effective treatment of neoplastic meningitis are lacking, due to the. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells and is becoming more common as cancer patients live longer. While this diagnosis carries a poor prognosis, early diagnosis and treatment can prevent neurologic deficits and extend survival with good quality of life. Apr 20, 2009 this retrospective comparison evaluated survival in 2 well. Enzon pharmaceuticals, piscataway, nj and skyepharma inc, san diego, ca to determine the maximumtolerated dose, the doselimiting toxicities, and the plasma and csf pharmacokinetics of it lipsomal cytarabine in children. We therefore reevaluated the sensitivity of gadolinium gdenhanced mri and cerebrospinalfluid csfcytology and the relevance of tumor type and csf cell count. Neoplastic meningitis palliative care network of wisconsin. A condition due to cancer that has spread from the original primary tumor to the meninges, the tissue covering the brain and spinal cord. Neoplastic meningitis is recognized clinically in 4% to 7% of patients with extraneural cancer, but it remains dramatically underdiagnosed.
Cohorts of 36 patients with nm were treated for 5 weeks with escalating doses of cpg28. Neoplastic meningitis nm developed 31 months after first diagnosis of simultaneous extra and intracranial recurrence of kidney cancer and surgical resection of a cerebellar metastasis. The treatment of neoplastic meningitis request pdf. Diagnosis is problematic because the disease is commonly the result of pleomorphic manifestations of neoplastic meningitis and cooccurrence of disease at other sites. Neoplastic meningitis nm is a common problem in neurooncology, occurring in approximately 5% of all patients with cancer. Neoplastic meningitis nm results from the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid csf compartment.