Neoplastic meningitis medical therapy: Difference between revisions
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===Supportive Care=== | ===Supportive Care=== | ||
Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen. | Supportive care should be directed towards all patients with neoplastic meningitis, regardless of the treatment regimen.<ref name="Chamberlain2008">{{cite journal|last1=Chamberlain|first1=M. C.|title=Neoplastic Meningitis|journal=The Oncologist|volume=13|issue=9|year=2008|pages=967–977|issn=1083-7159|doi=10.1634/theoncologist.2008-0138}}</ref> | ||
*[[Anticonvulsants]]: administered to the patients who have a [[seizure]]. | *[[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]]). | *[[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]]). | ||
Revision as of 22:19, 22 January 2016
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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]
Medical Therapy
The various treatment options for neoplastic meningitis include:[1]
Treatment of neoplastic meningitis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intrathecal chemotherapy | Radiotherapy | Surgery | Supportive care | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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
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