Leptomeningeal carcinomatosis from solid cancers in the era of molecular targeted therapy

Abstract

Leptomeningeal carcinoma is a devastating complication of solid cancers. The median survival time is less than two months without treatment. Eff ective management depends on early diagnosis. However, repeated CSF and MR examinations are often required for defi nitive diagnosis. Recent development of techniques in detecting circulating tumor cells may contribute to accurate diagnosis. Therapeutic options include local therapy with whole brain radiation therapy, primary cancer-specifi c systemic therapy and intra-CSF administration of anticancer drugs. Indication of treatment relates to the extent of neurologic burden of disease, systemic disease, estimated time of survival, and the available specific therapies. However, in the personalized treatment era, new therapies with improved CSF penetration have been developed for subgroups of molecular selected patients indicating they could be promising therapeutic options for managing leptomeningeal disease.