From The University of Texas M. D. Anderson Cancer Center, Houston, TX
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Morris D. Groves, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, 1400 Holcombe, Unit 431, Houston, TX 77030; e-mail: mgroves{at}mdanderson.org
Overview: Leptomeningeal metastases (LM) from systemic cancer occur in approximately 5% to 8% of patients with cancer. The most common solid tumors that cause LM are breast, lung, and melanoma. Because of increasing survival of patients with cancer and new large molecular weight anticancer drugs that poorly penetrate the brain and cerebrospinal fluid (CSF), the percentage of patients with cancer who develop LM may increase. LM is usually diagnosed late in a patient's disease course, with symptoms related to the cerebral hemispheres, cranial nerves, or spinal nerves. Treatment of LM is multidisciplinary, multifaceted, and complex, and it is targeted toward palliation, preservation of neurologic function, and prolongation of life. Interventions include radiotherapy, intrathecal (IT) chemotherapy, systemic chemotherapy, and surgery for CSF access or diversion. With current therapies, survival in patients with LM is uniformly disappointing because of the development of progressive neurologic disabilities and the relentless growth of central nervous system (CNS) and/or systemic cancers, ultimately leading to death, which usually occurs within 4 to 6 months. Advances in the understanding of the biology of CNS metastasis and of cancer metastasis in general, plus more effective and better delivered CNS and CSF anticancer drugs, are needed to improve outcomes for patients with LM. Areas of promise for treating LM include the IT use of monoclonal antibodies, newer and safer IT cytotoxic drugs, new CNS-penetrating systemic agents, and newly initiated multidrug combination studies. These advances may lead to better treatment or prevention of this disease, but a great deal of work must be done.
