Neoplastic meningitis medical therapy
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Treatment of neoplastic meningitis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intrathecal chemotherapy | Radiotherapy | Surgery | Supportive care | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
The mainstay of therapy for neoplastic meningitis is intrathecal chemotherapy.[1] Radiotherapy may be used in patients with neoplastic meningitis for palliation of symptoms, reduce the bulky tumors, and correction of cerebrospinal fluid flow abnormalities.[1] Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen (anticonvulsants, corticosteroids, and opiates).[1]
Medical Therapy
The various treatment options for neoplastic meningitis include:[1]
Chemotherapy
- The mainstay of therapy for neoplastic meningitis is intrathecal chemotherapy.[1]
- Chemotherapy can help in treatment of the total involved neuraxis. It may be administered systemically or intrathecally.
- Chemotherapy given via systemic route has poor CSF penetration, hence intrathecal chemotherapy is the preferred mode of administration.
- Chemotherapeutic drugs can be given intrathecally either by lumbar puncture or via an intraventricular reservoir system.
- Accessing via the intraventricular reservoir system is preferred to lumbar puncture for the following reasons:[1]
- Simple procedure
- More comfortable for the patient
- Safer than repeated lumbar punctures
- Better uniform distribution of the drug in the subarachnoid space
- Chemotherapeutic agents that are routinely used include:[1]
Radiotherapy
- Radiotherapy may be used in patients with neoplastic meningitis.[1]
- Indications for radiotherapy include:[1]
- Palliation of symptoms, such as cauda equina syndrome
- to reduce the bulky tumors, especially the coexistent parenchymal intracerebral metastases
- correction of cerebrospinal fluid flow abnormalities
Supportive Care
Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen.[1]
- Anticonvulsants: administered to the patients who have a seizure.
- Corticosteroids: usually dexamethasone, given 4-10 mg every 4-6 h, can reduce peritumoral edema and lower intracranial pressure with a decrease in symptoms (headache or drowsiness).
- Opiates: pain medication