Skip to main content
SpringerLink
Log in
Book cover

Adult CNS Radiation Oncology pp 201–217Cite as

Palliative Radiation Therapy for Leptomeningeal Disease

  • Chapter
  • First Online:

  • 1971 Accesses

Abstract

Approximately 5–10% of all patients with cancer will develop leptomeningeal metastatic disease (LM), often synchronously with parenchymal brain metastases and extracranial disease progression. The vast majority are symptomatic. As much of the literature is comprised of retrospective single-institution reviews of patients with various histologies treated heterogeneously, there is a lack of evidence supportive of a definitive treatment approach. Palliative external beam radiotherapy (RT) is most often delivered for LM disease, and when in the brain, typically the entire brain is treated with whole brain radiotherapy (WBRT); however, in the spine, typically RT is delivered regionally to areas of clinically relevant gross disease. The latter is due to the potential excessive toxicities associated with whole-spine radiation, in particular myelosuppression. The intent of RT is to stabilize or improve symptoms in the short term; it is unlikely that RT improves survival.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. National Comprehensive Cancer Network version 1.2016. Central nervous system cancers. Pgs LEPT-1 to LEPT-4, MS-29 to MS-31.

    Google Scholar 

  2. Chamberlain M. Combined-modality treatment of leptomeningeal gliomatosis. Neurosurgery. 2003;52(2):324–30.

    Article  PubMed  Google Scholar 

  3. Wasserstrom W, Glass J, Posner J. Diagnosis and treatment of leptomeningeal metastases from solid tumours: experience with 90 patients. Cancer. 1982;49:759–72.

    Article  CAS  PubMed  Google Scholar 

  4. Little J, Dale A, Okazaki H. Meningeal carcinomatosis. Arch Neurol. 1974;30:138–43.

    Article  CAS  PubMed  Google Scholar 

  5. Mack F, Baumert B, Schafer N, et al. Therapy of leptomeningeal metastasis in solid tumours. Cancer Treat Rev. 2016;43:83–91.

    Article  CAS  PubMed  Google Scholar 

  6. Clarke J, Perez H, Jacks L, et al. Leptomeningeal metastases in the MRI era. Neurology. 2010;74(18):1449–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Caraceni A, Martini C, Simonetti M. Neurological problems in advanced cancer. In: Doyle D, Hanks G, Cherny N, Calman K, editors. Oxford textbook of palliative medicine. 3rd ed. UK: Oxford University Press; 2005.

    Google Scholar 

  8. Olson M, Chernik N, Posner J. Infiltration of the leptomeninges by systemic cancer: a clinical and pathologic study. Arch Neurol. 1974;30:122–37.

    Article  CAS  PubMed  Google Scholar 

  9. Glass J, Melamed M, Chernik N, et al. Malignant cells in the cerebrospinal fluid: the meaning of a positive CSF cytology. Neurology. 1979;29:1369–75.

    Article  CAS  PubMed  Google Scholar 

  10. Rosen S, Aisner J, Makuch R, et al. Carcinomatous leptomeningitis in small cell lung cancer. Medicine. 1982;61(1):45–53.

    Article  CAS  PubMed  Google Scholar 

  11. Huang A, Huang K, Page B, et al. Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery. J Neurooncol. 2014;120:163–9.

    Article  PubMed  Google Scholar 

  12. Bartsch R, Berghoff A, Preusser M. Optimal management of brain metastases from breast cancer. CNS Drugs. 2013;27:121–34.

    Article  CAS  PubMed  Google Scholar 

  13. Waki F, Ando M, Takashima A, et al. Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumours. J Neurooncol. 2009;93:205–12.

    Article  PubMed  Google Scholar 

  14. Pavlidis N. The diagnostic and therapeutic management of leptomeningeal carcinomatosis. Ann Oncol. 2004;15(Suppl 4):iv285–91.

    PubMed  Google Scholar 

  15. Ihde D, Glatstein E, Pass H. Small cell lung cancer. In: DeVita V, Hellman S, Rosenberg S, editors. Cancer: principles & practice of oncology. 5th ed. USA: Lippincott-Raven; 1997.

    Google Scholar 

  16. Aisner J, Aisner S, Ostrow S, et al. Meningeal carcinomatosis from small cell carcinoma of the lung. Acta Cytol. 1979;23(4):292–6.

    PubMed  CAS  Google Scholar 

  17. Gonzalez-Vitale J, Garcia-Bunuel R. Meningeal carcinomatosis. Cancer. 1976;37:2906–11.

    Article  CAS  PubMed  Google Scholar 

  18. DeAngelis L, Boutros D. Leptomeningeal metastasis. Cancer Investig. 2005;23:145–54.

    Article  Google Scholar 

  19. Lee SJ, Lee JI, Nam DH, et al. Leptomeningeal carcinomatosis in non-small cell lung cancer patients: impact on survival and correlated prognostic factors. J Thorac Oncol. 2013;8(2):185–91.

    Article  PubMed  Google Scholar 

  20. Ozdemir Y, Yildirim B, Topkan E. Whole brain radiotherapy in management of non-small cell carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors. J Neurooncol. 2016;129:329–35.

    Article  PubMed  Google Scholar 

  21. Morris P, Reiner A, Rosenvald Szenberg O, et al. Leptomeningeal metastasis from non-small cell lung cancer: survival and the impact of whole brain radiotherapy. J Thorac Oncol. 2012;7(2):382–5.

    Article  PubMed  Google Scholar 

  22. Nugent J, Bunn P, Matthews M, et al. CNS metastases in small cell bronchogenic carcinoma: increasing frequency and changing pattern with lengthening survival. Cancer. 1979;44:1885–93.

    Article  CAS  PubMed  Google Scholar 

  23. Clarke J. Leptomeningeal metastasis from systemic cancer. Continuum (Minneap Minn). 2012;18(2):328–42.

    Google Scholar 

  24. Griffo Y, Obbens E. Neurological complications. In: Walsh D, Caraceni A, Fainsinger R, Foley K, Glare P, Goh C, Lloyd-Williams M, Nunez Olarte JM, Radbruch L, editors. Palliative medicine. New York: Saunders Elsevier; 2009.

    Google Scholar 

  25. Van der Ree T, Dippel D, Avezaat C, et al. Leptomeningeal metastasis after surgical resection of brain metastasis. J Neurol Neurosurg Psychiatry. 1999;66(2):225–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Liaw C, Ng K, Huang J, et al. Meningeal carcinomatosis from solid tumours: clinical analysis of 42 cases. J Formos Med Assoc. 1992;91:299–303.

    PubMed  CAS  Google Scholar 

  27. Foley KM. Acute and chronic cancer pain syndromes. In: Doyle D, Hanks G, Cherny N, Calman K, editors. Oxford textbook of palliative medicine. 3rd ed. UK: Oxford University Press; 2005.

    Google Scholar 

  28. Feyer P, Sautter-Bihl ML, Budach W, et al. DEGRO practical guidelines for palliative radiotherapy of breast cancer patients: brain metastases and leptomeningeal carcinomatosis. Strahlenther Onkol. 2010;186:63–9.

    Article  PubMed  Google Scholar 

  29. Mittl R Jr, Yousem D. Frequency of unexplained meningeal enhancement in the brain after lumbar puncture. Am J Neuroradiol. 1994;15(4):633–8.

    PubMed  Google Scholar 

  30. Freilich R, Krol G, DeAngelis L. Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol. 1995;38:51–7.

    Article  CAS  PubMed  Google Scholar 

  31. Chamberlain M. Comparative spine imaging in leptomeningeal metastases. J Neurooncol. 1995;23:233–8.

    Article  CAS  PubMed  Google Scholar 

  32. Cheng T, O’Neill B, Scheithauer B, et al. Chronic meningitis: the role of meningeal or cortical biopsy. Neurosurgery. 1994;34:590–5.

    PubMed  CAS  Google Scholar 

  33. Chamberlain M. Leptomeningeal metastasis. Curr Opin Neurol. 2009;22:665–74.

    Article  CAS  PubMed  Google Scholar 

  34. Shapiro W, Johanson C, Boogerd W. Treatment modalities for leptomeningeal metastases. Semin Oncol. 2009;36(4 Suppl 2):S46–54.

    Article  CAS  PubMed  Google Scholar 

  35. Mason W, DeAngelis L, Yeh S. 111Indium-DPTA cerebrospinal fluid studies in leptomeningeal metastases predict intrathecal methotrexate distribution and outcome in patients with leptomeningeal metastases. Neurology. 1998;50:438–43.

    Article  CAS  PubMed  Google Scholar 

  36. Kak M, Nanda R, Ramsdale E, et al. Treatment of leptomeningeal carcinomatosis: current challenges and future opportunities. J Clin Neurosci. 2015;22:632–7.

    Article  PubMed  Google Scholar 

  37. Chamberlain M, Goulart B. Are prognostic factors for leptomeningeal metastases defined sufficiently to permit tailored treatment? J Thorac Oncol. 2013;8(7):E66–7.

    Article  PubMed  Google Scholar 

  38. Chamberlain M, Eaton K. Is there a role for whole brain radiotherapy in the treatment of leptomeningeal metastases? J Thorac Oncol. 2012;7(7):1204.

    Article  PubMed  Google Scholar 

  39. Chamberlain M, Soffietti R, Raizer J, et al. Leptomeningeal metastases: a response assessment in neuro-oncology critical review of endpoints and response criteria of published randomized clinical trials. Neuro Oncol. 2014;16:1176–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Glantz M, Hall W, Cole B, et al. Diagnosis, management and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status. Cancer. 1995;75:2919–31.

    Article  CAS  PubMed  Google Scholar 

  41. Elmore S, Balboni T. Symptom control and predictors of survival in leptomeningeal carcinomatosis of the neuraxis treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2015;93(3 Suppl):E478–9. Abstr 3195

    Article  Google Scholar 

  42. Boogerd W, Hart A, van der Sande J, et al. Meningeal carcinomatosis in breast cancer: prognostic factors and influence of treatment. Cancer. 1991;67:1685–95.

    Article  CAS  PubMed  Google Scholar 

  43. Gani C, Muller A, Eckert F, et al. Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumours. Strahlenther Onkol. 2012;188:148–53.

    Article  CAS  PubMed  Google Scholar 

  44. Omuro A, Lallana E, Bilsky M, et al. Ventriculoperitoneal shunt in patients with leptomeningeal metastasis. Neurology. 2005;64:1625–7.

    Article  PubMed  Google Scholar 

  45. Jung T, Chung W, Oh I. The prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases. Clin Neurol Neurosurg. 2014;119:80–3.

    Article  PubMed  Google Scholar 

  46. Mackillop WJ. The principles of palliative radiotherapy: a radiation oncologist’s perspective. Can J Oncol. 1996;6(Suppl 1):5–11.

    PubMed  Google Scholar 

  47. Chamberlain M, Kormanik P. Prognostic significance of 111indium-DTPA CSF flow studies in leptomeningeal metastases. Neurology. 1996;46:1674–7.

    Article  CAS  PubMed  Google Scholar 

  48. Grossman S, Trump C, Chen D, et al. Cerebrospinal fluid abnormalities in patients with neoplastic meningitis. Am J Med. 1982;73:641–7.

    Article  CAS  PubMed  Google Scholar 

  49. Siegal T, Lossos A, Pfeffer M. Leptomeningeal metastases: analysis of 31 patients with sustained off-therapy response following combined modality therapy. Neurology. 1994;44:1463–9.

    Article  CAS  PubMed  Google Scholar 

  50. Boogerd W, van den Bent M, Koehler P, et al. The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomized study. Eur J Cancer. 2004;40:2726–33.

    Article  CAS  PubMed  Google Scholar 

  51. Aisner J, Ostrow S, Govindan S, et al. Leptomeningeal carcinomatosis in small cell carcinoma of the lung. Med Pediatr Oncol. 1981;9:47–59.

    Article  CAS  PubMed  Google Scholar 

  52. Jo K, Lim D, Kim S, et al. Leptomeningeal seeding in patients with brain metastases treated by gamma knife radiosurgery. J Neurooncol. 2012;109:293–9.

    Article  PubMed  Google Scholar 

  53. Hashimoto K, Narita Y, Miyakita Y, et al. Comparison of clinical outcomes of surgery followed by local brain radiotherapy and surgery followed by whole brain radiotherapy in patients with a single brain metastasis: Single Centre retrospective analysis. Int J Radiat Oncol Biol Phys. 2011;81:E475–80.

    Article  PubMed  Google Scholar 

  54. Suki D, Abouassi H, Patel A, et al. Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumour metastasis to the posterior fossa. J Neurosurg. 2008;108:248–57.

    Article  PubMed  Google Scholar 

  55. Sause W, Crowley J, Eyre H, et al. Whole brain irradiation and intrathecal methotrexate in the treatment of solid tumour leptomeningeal metastases – a Southwest Oncology Group study. J Neurooncol. 1988;6:107–12.

    Article  CAS  PubMed  Google Scholar 

  56. Victoria Hospice Society Learning Centre for Palliative Care. In: Downing GM, Wainwright W, editors. Medical care of the dying. 4th ed. Victoria: Victoria Hospice Society; 2006.

    Google Scholar 

  57. Dudani S, Mazzarello S, Hilton J, et al. Optimal management of leptomeningeal carcinomatosis in breast cancer patients: a systematic review. Clin Breast Cancer. 2016;16(6):456–70.

    Article  PubMed  Google Scholar 

  58. Heathfield K, Williams J. Carcinomatosis of the meninges: clinical and pathological aspects. Br Med J. 1956;1(4962):328–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Emoto S, Ishigami H, Yamaguchi H, et al. Frequent development of leptomeningeal carcinomatosis in patients with peritoneal dissemination of gastric cancer. Gastric Cancer. 2011;14:390–5.

    Article  PubMed  Google Scholar 

  60. Lukas R, Mata-Machado N, Nicholas M, et al. Leptomeningeal carcinomatosis in esophagus cancer: a case series and systematic review of the literature. Dis Esophagus. 2015;28:772–81.

    Article  CAS  PubMed  Google Scholar 

  61. Grommes C, Oxnard G, Kris M, et al. Pulsatile high-dose weekly erlotinib for CNS metastases from EGFR mutant non-small cell lung cancer. Neuro Oncol. 2011;13(12):1364–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Eichler A, Kahle K, Wang D, et al. EGFR mutation status and survival after diagnosis of brain metastasis in non-small cell lung cancer. Neuro Oncol. 2010;12:1193–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Hata A, Katakami N, Kaji R, et al. Erlotinib for whole brain radiotherapy refractory leptomeningeal metastases after gefitinib failure in a lung adenocarcinoma patient. J Thorac Oncol. 2012;7(4):770–1.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada

    Alysa M. Fairchild

Authors
  1. Alysa M. Fairchild
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alysa M. Fairchild .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, Keck School of Medicine of USC, Norris Cancer Hospital, Los Angeles, California, USA

    Eric L. Chang

  2. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA

    Paul D. Brown

  3. Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, USA

    Simon S. Lo

  4. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Arjun Sahgal

  5. Department of Radiation Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio, USA

    John H. Suh

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fairchild, A.M. (2018). Palliative Radiation Therapy for Leptomeningeal Disease. In: Chang, E., Brown, P., Lo, S., Sahgal, A., Suh, J. (eds) Adult CNS Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42878-9_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42878-9_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42877-2

  • Online ISBN: 978-3-319-42878-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation