Overview
Leptomeningeal metastasis (LM) refers to the spread of cancer cells to the leptomeninges, the membranes surrounding the brain and spinal cord 1. It is a serious complication of solid tumors, often associated with poor prognosis 1.Diagnosis
Diagnosis involves a combination of clinical suspicion, neuroimaging, and cerebrospinal fluid (CSF) analysis 1.
Neuroimaging, particularly MRI of the brain and spine with contrast, is crucial for detecting leptomeningeal enhancement 1.
CSF cytology is essential for confirming the presence of malignant cells 1.
Staging and risk assessment are part of the diagnostic workup 1.Management
Treatment strategies are tailored to the primary tumor type, patient performance status, and extent of leptomeningeal disease 1.
Systemic therapy, including targeted agents and chemotherapy, is a cornerstone of treatment 1.
Radiation therapy may be used for symptomatic sites of leptomeningeal disease 1.
Intrathecal chemotherapy can be considered in select cases 1.
Supportive care, including corticosteroids and analgesics, is important for symptom management 1.Special Populations
No information on special populations (pregnancy, pediatrics, elderly, comorbidities) was provided in the abstracts.Key Recommendations
Diagnosis should be confirmed by neuroimaging and CSF cytology 1. (Evidence: Expert opinion)
Treatment decisions should be individualized based on tumor type, performance status, and disease burden 1. (Evidence: Expert opinion)
A multidisciplinary approach involving neurologists, oncologists, and radiation oncologists is recommended for optimal management 1. (Evidence: Expert opinion)References
1 Le Rhun E, Weller M, van den Bent M, Brandsma D, Furtner J, Rudà R et al.. Leptomeningeal metastasis from solid tumours: EANO-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO open 2023. link