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Article Dans Une Revue Memo Année : 2021

Leptomeningeal metastases from solid tumours


Leptomeningeal metastases from solid tumours are increasingly being diagnosed and require a careful assessment by an interdisciplinary neuro-oncological tumour board for adequate diagnosis, therapy planning and optimal care of the affected patients. An increasing number of patients with metastatic cancer are developing leptomeningeal dissemination due to better therapies and longer survival. In a brief review, we will focus on leptomeningeal disease arising from solid tumours and inform about current management and future directions. Leptomeningeal metastases (LM) are defined by the presence of metastatic tumour cells within the leptomeninges and the subarachnoid space. Overall, leptomeningeal involvement is diagnosed in about 10–15% of patients with metastatic solid tumours, with an increasing tendency, due to longer survival of patients with the associated tumours and better access to modern imaging. Three tumour entities are particularly prone to spread to the meninges: (1) breast cancer [1], (2) lung cancer, notably molecular driven subtypes of NSCLC and SCLC, and, (3) melanoma. The highest incidence of LM appears to be in melanoma (23%) and lung cancer (9–25%) then followed by breast cancer (5%). Considering the high incidence of breast cancer worldwide, in absolute numbers it constitutes the most common aetiology of LM. Rarely, leptomeningeal metastases are a first tumour manifestation. Concurrent systemic disease progression is seen in up to 60–70% of patients. Brain metastases are noted in about 40%, half of them progressing at leptomeningeal metastases diagnosis, new brain metastases have been reported in 20% [2, 3]. Prognosis of leptomeningeal tumour manifestation is generally poor, with a median survival limited to a few months in most patient cohorts, with the exception of molecularly altered tumours which are accessible to targeted drugs and a longer disease control may therefore be expected. A literature search on this particular tumour manifestation provides information on the following terms: “meningeosis carcinomatosa”, “carcinomatous meningitis”, “neoplastic meningitis”, “leptomeningeal carcinomatosis” and “leptomeningeal metastases”. Hereafter, the term leptomeningeal metastases will be used, abbreviated as “LM”.
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hal-04018984 , version 1 (04-04-2023)




Silvia Hofer, Emilie Le Rhun. Leptomeningeal metastases from solid tumours. Memo, 2021, Memo, 14, pp.192-197. ⟨10.1007/s12254-021-00693-6⟩. ⟨hal-04018984⟩


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