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Journal of Drug Delivery
Volume 2013, Article ID 147325, 6 pages
http://dx.doi.org/10.1155/2013/147325
Review Article

Neoplastic Meningitis from Solid Tumors: A Prospective Clinical Study in Lombardia and a Literature Review on Therapeutic Approaches

1Fondazione I.R.C.C.S. Istituto Neurologico C. Besta, Milano, Italy
2Clinica Neurochirurgica, Ospedale Policlinico, Milano, Italy
3Ospedale Melegnano, Milano, Italy
4Ospedali Riuniti Bergamo, Milano, Italy
5Ospedale di Lodi, Lodi, Italy
6Ospedale Niguarda, Milano, Italy
7Ospedale Lecco, Lombardy, Italy

Received 7 December 2012; Accepted 20 December 2012

Academic Editor: Michele Caraglia

Copyright © 2013 A. Silvani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Neoplastic dissemination to the leptomeninges is an increasingly common occurrence in patients with both haematological and solid tumors arising outside the central nervous system. Both refinement of diagnostic techniques (Magnetic resonance imaging) and increased survival in patients treated with targeted therapies for systemic tumors account for this increased frequency. Cerebrospinal fluid cytological analysis and MRI confirm clinical diagnosis based on multifocal central nervous system signs/symptoms in a patient with known malignancy. Overall survival in patients with leptomeningeal neoplastic dissemination from solid tumors is short, rarely exceeding 3-4 months. However, selected patients may benefit from aggressive therapies, Apart from symptomatic treatment, intrathecal chemotherapy is used, with both free (methotrexate, Thiotepa, AraC) and liposomal antitumor agents (liposomal AraC). Palliative radiotherapy is indicated only in cases of symptomatic bulky disease, surgery is limited to positioning of Ommaya recervoirs or C5F shunting. We report clinical data on a cohort of 26 prospectively followed patients with neoplastic leptomeningitis followed in Lombardia, Italy, in 2011. Prognostic factors and pattern of care are reported.