Seth Joseffer, MD, FACS
"I hope this article helps our patients and their families understand more about this challenging problem."
Leptomeningeal carcinomatosis is a serious complication of cancer that has high rates of morbidity and mortality. It may occur at any stage in the neoplastic disease, either as the presenting sign or as a late complication. It is frequently associated with the relapse of cancer at another location in the body. The disorder was originally reported by Eberth in 1870. Although originally considered to be a rare complication, it has become more commonly diagnosed as cancer patients live longer and our diagnostic tools improve. Inside the brain, there are areas that are filled with cerebrospinal fluid (CSF). This fluid also flows into the spinal cord through an outlet at the base of the brain.
Leptomeningeal carcinomatosis (LC) occurs when cancer cells invade and proliferate within the cerebrospinal fluid.
The leptomeninges consists of the arachnoid membrane and the pia mater. The space separating the arachnoid membrane and the pia mater is referred to as the subarachnoid space, and this is this space containsthe cerebrospinal fluid (CSF). Tumors of diverse origins and hematologic cancers may spread to this space. When tumor cells enter the CSF they are transported throughout the nervous system by the normal flow of CSF.
Diagnosis of LC is most commonly made by lumbar puncture although the tests may be negative in roughly 10% of patients with leptomeningeal carcinomatosis. Unfortunately, treatment options are limited. Without treatment, the median survival of patients after diagnosis with this disorder is in the neighborhood of 4-6 weeks. The actual cause of death is progressive neurologic dysfunction. Early diagnosis and therapy is critical to preserving neurologic function. Radiation therapy to symptomatic sites, combined with intrathecal chemotherapy may increase the median survival to 3-6 months.
Never give up hope. In rare cases, some patients with certain types of cancer that get carcinomatous meningitis can live years with appropriate treatment.
For further information about Leptomeningeal Carcinomatosis:
Leptomeningeal carcinomatosis: Prognostic value of clinical, cerebrospinal fluid, and neuroimaging features Clinical Neurology & Neurosurgery