Neoplastic meningitis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Neoplastic meningitis}} | {{Neoplastic meningitis}} | ||
{{familytree/start |summary=Treatment of neoplastic meningitis}} | |||
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | A01| | | | | | | | | | | | | |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of neoplastic meningitis'''</div>}} | |||
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | | | | | | | | | | |}} | |||
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | B02 | | B03 | | B04 | | | | | | | | | | | | | |B01=<div style="width: 9em; padding:0.2em;">'''Intrathecal<br>chemotherapy<br>''' </div>|B02=<div style="width: 9em; padding:0.2em;">'''Radiotherapy'''</div>|B03=<div style="width: 9em; padding:0.2em;">'''Surgery'''</div>||B04=<div style="width: 9em; padding:0.2em;">'''Supportive care'''</div>}} | |||
{{familytree/end}} | |||
{{CMG}}{{AE}}{{SR}} | {{CMG}}{{AE}}{{SR}} | ||
==Overview== | ==Overview== | ||
The mainstay of therapy for neoplastic meningitis is [[intrathecal chemotherapy]].<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | The mainstay of therapy for neoplastic meningitis is [[intrathecal chemotherapy]].<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> [[Radiotherapy]] may be used in patients with neoplastic meningitis for palliation of symptoms, reduce the bulky tumors, and correction of cerebrospinal fluid flow abnormalities.<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen ([[anticonvulsants]], [[corticosteroids]], and [[opiates]]).<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
The various treatment options for neoplastic meningitis include:<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | The various treatment options for neoplastic meningitis include:<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | ||
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*The mainstay of therapy for neoplastic meningitis is [[intrathecal chemotherapy]].<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | *The mainstay of therapy for neoplastic meningitis is [[intrathecal chemotherapy]].<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | ||
*Chemotherapy can help in treatment of the total involved [[neuraxis]]. It may be administered systemically or intrathecally. | *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. | *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: | *Accessing via the intraventricular reservoir system is preferred to lumbar puncture for the following reasons:<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | ||
:*Simple procedure | :*Simple procedure | ||
:*More comfortable for the patient | :*More comfortable for the patient | ||
:*Safer than repeated lumbar punctures | :*Safer than repeated lumbar punctures | ||
:*Better uniform distribution of the drug in the subarachnoid space | :*Better uniform distribution of the drug in the subarachnoid space | ||
*Chemotherapeutic agents that are routinely used include:<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | |||
:*[[Methotrexate]] | |||
:*[[Cytarabine]] | |||
:*[[Thiotepa]] | |||
===Radiotherapy=== | |||
*[[Radiotherapy]] may be used in patients with neoplastic meningitis.<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | |||
*Indications for radiotherapy include:<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | |||
:*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.<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | |||
*[[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 | |||
==References== | ==References== | ||
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Latest revision as of 19:05, 12 August 2019
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Treatment of neoplastic meningitis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intrathecal chemotherapy | Radiotherapy | Surgery | Supportive care | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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]
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]
- 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