LEPTOMENINGEAL CARCINOMATOSIS

Leptomeningeal carcinomatosis is a neurological complication of several systemic tumors, and is characterized by multifocal invasion of the leptomeninges and subarachnoid space by neoplastic cells. Leptomeningeal carcinomatosis occurs in approximately 5% of patients with cancer. Among solid tumors, breast cancer, lung cancer, and melanoma are the primary tumors most frequently associated with leptomeningeal carsinomatosis. The diagnosis is most commonly made by lumbar puncture although the cerebrospinal fluid cytology is persistently negative in about 10% of patients with leptomeningeal carcinomatosis. In patients with known cancer, magnetic resonans scan with gadolinium may be diagnostic when subarachnoid nodules can be demonstrated in the head or spine. Treatment of leptomeningeal carcinomatosis is currently palliative for most patients, with an expected median survival of less than 6 months. Therapy usually involves radiotherapy to symptomatic sites, often followed by intrathecal chemotherapy. New therapies for leptomeningeal carcinomatosis that are currently under investigation include hormonal therapy, monoclonal antibodies, signal transduction inhibitors, and gene therapy.

Keywords: Leptomeningeal carcinomatosis, diagnosis, treatment