Neoplastic Meningitis

BACKGROUND: Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer. REVIEW SUMMARY: Notwithstanding frequent focal signs and symptoms in NM, NM is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments. RESULTS: Central nervous system (CNS) staging of NM includes contrast-enhanced cranial computed tomography (CE-CT) or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging (MR-S) or computed tomographic myelography (CT-M), and radionuclide CSF flow study (FS). Treatment of NM incorporates involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with NM and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to 3 chemotherapeutic agents (ie, methotrexate, cytosine arabinoside, and thio-TEPA) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. CONCLUSIONS: Although treatment of NM is palliative, with an expected median patient survival of 2 to 6 months, it often affords stabilization and protection from further neurologic deterioration in patients with NM.