Neoplastic meningitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

The mainstay of therapy for neoplastic meningitis is intrathecal chemotherapy.[1] Radiotherapy may be used in patients with neoplastic meningitis for palliation of symptoms, reduce the bulky tumors, and correction of cerebrospinal fluid flow abnormalities.[1] Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen (anticonvulsants, corticosteroids, and opiates).[1]

Medical Therapy

The various treatment options for neoplastic meningitis include:[1]

 
 
 
 
 
 
 
 
 
 
 
 
Treatment of neoplastic meningitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intrathecal
chemotherapy
 
Radiotherapy
 
Surgery
 
Supportive care
 
 
 
 
 
 
 
 
 
 
 
 
 


Chemotherapy

  • The mainstay of therapy for neoplastic meningitis is intrathecal chemotherapy.[1]
  • Chemotherapy can help in treatment of the total involved neuraxis. It may be administered systemically or intrathecally.
  • Chemotherapy given via systemic route has poor CSF penetration, hence intrathecal chemotherapy is the preferred mode of administration.
  • Chemotherapeutic drugs can be given intrathecally either by lumbar puncture or via an intraventricular reservoir system.
  • Accessing via the intraventricular reservoir system is preferred to lumbar puncture for the following reasons:[1]
  • Simple procedure
  • More comfortable for the patient
  • Safer than repeated lumbar punctures
  • Better uniform distribution of the drug in the subarachnoid space
  • Chemotherapeutic agents that are routinely used include:[1]

Radiotherapy

  • Radiotherapy may be used in patients with neoplastic meningitis.[1]
  • Indications for radiotherapy include:[1]
  • Palliation of symptoms, such as cauda equina syndrome
  • to reduce the bulky tumors, especially the coexistent parenchymal intracerebral metastases
  • correction of cerebrospinal fluid flow abnormalities

Supportive Care

Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Chamberlain, M. C. (2008). "Neoplastic Meningitis". The Oncologist. 13 (9): 967–977. doi:10.1634/theoncologist.2008-0138. ISSN 1083-7159.

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