Neoplastic meningitis medical therapy
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Treatment of neoplastic meningitis
The mainstay of therapy for neoplastic meningitis is intrathecal chemotherapy. Radiotherapy may be used in patients with neoplastic meningitis for palliation of symptoms, reduce the bulky tumors, and correction of cerebrospinal fluid flow abnormalities. Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen (anticonvulsants, corticosteroids, and opiates).
The various treatment options for neoplastic meningitis include:
- The mainstay of therapy for neoplastic meningitis is intrathecal chemotherapy.
- 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:
- 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:
- Radiotherapy may be used in patients with neoplastic meningitis.
- Indications for radiotherapy include:
- 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 should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen.
- Anticonvulsants: administered to the patients who have a seizure.
- Corticosteroids: usually dexamethasone, given 4-10 mg every 4-6 h, can reduce peritumoral edema and lower intracranial pressure with a decrease in symptoms (headache or drowsiness).
- Opiates: pain medication