treated may vary and can range from very limited
radiation therapy to irradiation of the entire neuroaxis (craniospinal radiation therapy). This decision may depend on many factors including the
sites involved, neurological symptoms, functional
status, extent of extracranial disease, and likelihood of response to other therapies.
Treatment consisted of radiation therapy to
the caudal equina area with improvement in
urinary incontinence. Following radiation therapy, intrathecal liposomal cytarabine was administered via
an Ommaya reservoir with clearing of CSF cytology
after 3 doses. The patient remained neurologically
stable, but developed new lung metastases which
were unresponsive to salvage treatment and resulted in significant functional impairment. She decided
to pursue comfort care and died shortly thereafter.
Metastatic disease to the central nervous sys-
tem is an issue that has become more significant
as patients survive longer with cancer. Brain me-
tastases and leptomeningeal metastases are 2
types of central nervous system metastases which
require careful selection of treatment modalities for
each individual patient. The prognosis is generally
poor for both conditions, but prognostic factors
have been identified which help to stratify patients
and determine the appropriateness of available
therapies. In addition to treatment of malignancy,
management of neurological complications is im-
portant in managing these patients. More effec-
tive therapies for these conditions are essential,
as they represent a critical obstacle to the overall
progress of cancer treatment.
Table 7. Agents That Have Been Administered into Cerebrospinal
Fluid for Leptomeningeal Metastasis
Liposomal cytarabine (DepoCyt)
*Perissinotti AJ, Reeves DJ. Role of intrathecal rituximab and trastuzumab in the management of leptomeningeal carcinomatosis. Ann
Table 8. Chemotherapy Options in Leptomeningeal Metastasis.
*Rogers LR, Remer SE, Tejwani S. Durable response of breast cancer
leptomeningeal metastasis to capecitabine monotherapy. Neuro Oncol
†Ostermann S, Csajka C, Buclin T, et al. Plasma and cerebrospinal fluid
population pharmacokinetics of temozolomide in malignant glioma patients. Clin Cancer Res 2004;10:3728–36.
Adapted from Berg SL, Chamberlain MC. Systemic chemotherapy,
intrathecal chemotherapy, and symptom management in the treatment
of leptomeningeal metastasis. Curr Oncol Rep 2003;5:29–40.
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