Neoplastic Meningitis From Systemic Malignancies

Diagnosis, Prognosis and Treatment

Kurt Jaeckle

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Long-term survival is occasionally observed in patients with neoplastic meningitis (NM) accompanying breast cancer (13% one-year and 6% 2-year survival), melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months. The incidence of NM appears to be increasing, in part due to earlier detection by magnetic resonance imaging (MRI), and in part due to development of more effective therapies for systemic cancer, which has resulted in a larger subset at risk for late-stage development of this complication. Survival of NM patients is negatively affected by concomitant progression of systemic disease despite multiple prior therapies. However, there are certain prognostic factors that have been identified as "favorable" in retrospective series, including age less than 60 years, long symptom duration, controlled systemic disease, Karnofsky performance status (KPS) ≥70, lack of encephalopathy or cranial nerve deficits, low initial cerebrospinal fluid (CSF) protein level, history of breast primary tumor, and lack of evidence of CSF compartmentalization or bulky meningeal disease as determined by CSF flow studies. Standard treatment has traditionally involved radiotherapy (RT) to sites of symptomatic or bulky disease, as detected by neuroimaging, and in selected patients, the administration of intrathecal, intraventricular, or systemic chemotherapy. However, treatment remains palliative and many patients and physicians choose supportive care only. Future hope is provided by studies that have improved our understanding of the disease pathogenesis, have identified prognostic variables associated with outcome, and have provided new therapeutic approaches, such as administration of high-dose systemic chemotherapy and investigations of novel therapeutic agents.

Original languageEnglish (US)
Pages (from-to)312-323
Number of pages12
JournalSeminars in Oncology
Volume33
Issue number3
DOIs
StatePublished - Jun 1 2006

Fingerprint

Meningitis
Survival
Neoplasms
Cerebrospinal Fluid
Breast Neoplasms
Cerebrospinal Fluid Proteins
Therapeutics
Karnofsky Performance Status
Drug Therapy
Cranial Nerves
Brain Diseases
Palliative Care
Neuroimaging
Disease Progression
Melanoma
Lymphoma
Radiotherapy
Magnetic Resonance Imaging
Physicians
Incidence

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology

Cite this

@article{baf5cabc4b4b4f7587174240465fde56,
title = "Neoplastic Meningitis From Systemic Malignancies: Diagnosis, Prognosis and Treatment",
abstract = "Long-term survival is occasionally observed in patients with neoplastic meningitis (NM) accompanying breast cancer (13{\%} one-year and 6{\%} 2-year survival), melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months. The incidence of NM appears to be increasing, in part due to earlier detection by magnetic resonance imaging (MRI), and in part due to development of more effective therapies for systemic cancer, which has resulted in a larger subset at risk for late-stage development of this complication. Survival of NM patients is negatively affected by concomitant progression of systemic disease despite multiple prior therapies. However, there are certain prognostic factors that have been identified as {"}favorable{"} in retrospective series, including age less than 60 years, long symptom duration, controlled systemic disease, Karnofsky performance status (KPS) ≥70, lack of encephalopathy or cranial nerve deficits, low initial cerebrospinal fluid (CSF) protein level, history of breast primary tumor, and lack of evidence of CSF compartmentalization or bulky meningeal disease as determined by CSF flow studies. Standard treatment has traditionally involved radiotherapy (RT) to sites of symptomatic or bulky disease, as detected by neuroimaging, and in selected patients, the administration of intrathecal, intraventricular, or systemic chemotherapy. However, treatment remains palliative and many patients and physicians choose supportive care only. Future hope is provided by studies that have improved our understanding of the disease pathogenesis, have identified prognostic variables associated with outcome, and have provided new therapeutic approaches, such as administration of high-dose systemic chemotherapy and investigations of novel therapeutic agents.",
author = "Kurt Jaeckle",
year = "2006",
month = "6",
day = "1",
doi = "10.1053/j.seminoncol.2006.04.016",
language = "English (US)",
volume = "33",
pages = "312--323",
journal = "Seminars in Oncology",
issn = "0093-7754",
publisher = "W.B. Saunders Ltd",
number = "3",

}

Neoplastic Meningitis From Systemic Malignancies : Diagnosis, Prognosis and Treatment. / Jaeckle, Kurt.

In: Seminars in Oncology, Vol. 33, No. 3, 01.06.2006, p. 312-323.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Neoplastic Meningitis From Systemic Malignancies

T2 - Diagnosis, Prognosis and Treatment

AU - Jaeckle, Kurt

PY - 2006/6/1

Y1 - 2006/6/1

N2 - Long-term survival is occasionally observed in patients with neoplastic meningitis (NM) accompanying breast cancer (13% one-year and 6% 2-year survival), melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months. The incidence of NM appears to be increasing, in part due to earlier detection by magnetic resonance imaging (MRI), and in part due to development of more effective therapies for systemic cancer, which has resulted in a larger subset at risk for late-stage development of this complication. Survival of NM patients is negatively affected by concomitant progression of systemic disease despite multiple prior therapies. However, there are certain prognostic factors that have been identified as "favorable" in retrospective series, including age less than 60 years, long symptom duration, controlled systemic disease, Karnofsky performance status (KPS) ≥70, lack of encephalopathy or cranial nerve deficits, low initial cerebrospinal fluid (CSF) protein level, history of breast primary tumor, and lack of evidence of CSF compartmentalization or bulky meningeal disease as determined by CSF flow studies. Standard treatment has traditionally involved radiotherapy (RT) to sites of symptomatic or bulky disease, as detected by neuroimaging, and in selected patients, the administration of intrathecal, intraventricular, or systemic chemotherapy. However, treatment remains palliative and many patients and physicians choose supportive care only. Future hope is provided by studies that have improved our understanding of the disease pathogenesis, have identified prognostic variables associated with outcome, and have provided new therapeutic approaches, such as administration of high-dose systemic chemotherapy and investigations of novel therapeutic agents.

AB - Long-term survival is occasionally observed in patients with neoplastic meningitis (NM) accompanying breast cancer (13% one-year and 6% 2-year survival), melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months. The incidence of NM appears to be increasing, in part due to earlier detection by magnetic resonance imaging (MRI), and in part due to development of more effective therapies for systemic cancer, which has resulted in a larger subset at risk for late-stage development of this complication. Survival of NM patients is negatively affected by concomitant progression of systemic disease despite multiple prior therapies. However, there are certain prognostic factors that have been identified as "favorable" in retrospective series, including age less than 60 years, long symptom duration, controlled systemic disease, Karnofsky performance status (KPS) ≥70, lack of encephalopathy or cranial nerve deficits, low initial cerebrospinal fluid (CSF) protein level, history of breast primary tumor, and lack of evidence of CSF compartmentalization or bulky meningeal disease as determined by CSF flow studies. Standard treatment has traditionally involved radiotherapy (RT) to sites of symptomatic or bulky disease, as detected by neuroimaging, and in selected patients, the administration of intrathecal, intraventricular, or systemic chemotherapy. However, treatment remains palliative and many patients and physicians choose supportive care only. Future hope is provided by studies that have improved our understanding of the disease pathogenesis, have identified prognostic variables associated with outcome, and have provided new therapeutic approaches, such as administration of high-dose systemic chemotherapy and investigations of novel therapeutic agents.

UR - http://www.scopus.com/inward/record.url?scp=33744942620&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744942620&partnerID=8YFLogxK

U2 - 10.1053/j.seminoncol.2006.04.016

DO - 10.1053/j.seminoncol.2006.04.016

M3 - Article

VL - 33

SP - 312

EP - 323

JO - Seminars in Oncology

JF - Seminars in Oncology

SN - 0093-7754

IS - 3

ER -