NEOPLASTIC MENINGITIS - A GUIDE TO DIAGNOSIS AND TREATMENT

Neoplastic meningitis (NM) is a common problem in neuro-oncology, occu rring in approximately 5% of all patients with cancer. Notwithstanding the frequent focal signs and symptoms, NM is a disease affecting the entire neuraxis and therefore staging and treatment need to encompass all CSF compartments. CNS staging of NM involves the use of contrast-e nhanced cranial computerised tomography (CE-CT) or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging (M R-S) or computerised tomographic myelography (CT-M) and radionuclide C SF flow study (FS). The main approaches to the treatment of NM are inv olved-field radiotherapy of bulky or symptomatic disease sites and int ra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with NM and may obviate the need for intra-CSF chemo therapy. At present, intra-CSF drug therapy is confined to 4 chemother apeutic agents [i.e. methotrexate, cytarabine (cytosine arabinoside), thiotepa and interferon-alpha] administered by a variety of schedules, either by intralumbar or intraventricular delivery. Although the trea tment of NM is palliative, with an expected median patient survival of 2 to 6 months, it often affords stabilisation and protection from fur ther neurological deterioration.