Meningeal carcinomatosis in solid tumours

Abstract

Leptomeningeal and CSF neoplastic cell metastatic involvement may be defined as meningeal carcinoma or carcinomatous meningitis. A significantly increased incidence has been observed in the last 20 years, generally attributed to improved control of the systemic disease with more effective therapy. Breast cancer is the most common malignancy associated with menigeal carcinomatosis, followed by lung cancer and melanoma. Dissemination of malignant cells in the subaracnoid space produces pleomorphic neurologic signs and symptoms, usually characterized by involvement of all neurological levels. Clinical suspicion and early diagnosis are essential to preserve neurological functions and quality of life. Leptomeningeal solid tumor involvement is associated with an unfavorable progression, usually a mean 2 to 4 month survival period. Treatment is essentially palliative, including radiotherapy and intrathecal and systemic chemotherapy. Adequate selection of patients with greater possibilities of benefiting from more aggressive treatment is crucial. This paper, based on MEDLINE data between 1970 and 2000, is a review of literature on this theme.