termsTerm
Leptomeningeal disease
aka leptomeningeal, leptomeningeal metastases, leptomeningeal carcinomatosis, carcinomatous meningitis
Cancer cells spreading in the fluid and membranes that bathe the brain and spinal cord, rather than as a solid lump. It causes headaches, nerve palsies and confusion and has been one of the hardest situations to treat.
Occurs in 5-10% of solid tumours (breast, lung, melanoma) and in leukaemia and lymphoma; diagnosed by MRI and cerebrospinal fluid cytology or ctDNA. Median survival has been weeks to months. Treatments are intrathecal chemotherapy or trastuzumab, craniospinal radiotherapy (proton craniospinal showed benefit at MSK), and increasingly CNS-penetrant drugs such as osimertinib at high dose, tucatinib and T-DXd. CNS prophylaxis in high-risk leukaemia and lymphoma exists to prevent it.
Category
Anatomy