Neoplastic meningitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

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]

The various treatment options for neoplastic meningitis include:^[1]

• 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]

• Methotrexate
• Cytarabine
• Thiotepa

• 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 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

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