Neoplastic meningitis

Neoplastic meningitis (NM) is a common problem in neuro-oncology. Notwithstanding its frequent focal signs and symptoms, NM is a disease affecting the entire neuraxis, and therefore its staging and treatment must include all cerebrospinal fluid (CSF) compartments. Diagnosis of NM is conducted by magnetic resonance imaging (MR-Gd) and pathological examination using CSF. Treatments of NM include involved-field radiotherapy of bulky or symptomatic disease sites, systemic chemotherapy, or intra-CSF drug therapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (i. e., methotrexate, cytosine arabinoside, and thio-TEPA) administered in a variety of schedules either by intralumbar or intraventricular delivery. Although treatment of NM is palliative with an expected median patient survival of 2 to 6 months, it often affords stabilization and protection from further neurologic deterioration in patients with NM. Recently, liposomal cytarabine has been developed and introduced in several clinical trials, demonstrating promising results.