Skip to main content
Log in

Meningeosis neoplastica

Ausbreitung von Tumorzellen in Liquorraum und Hirnhäute – wie erkennen, wie behandeln?

  • TOPIC 2 · meningeosis neoplastica
  • Published:
best practice onkologie Aims and scope

Zusammenfassung

Meningeosis neoplastica bezeichnet eine diffuse Aussaat von Tumorzellen in Liquor und Hirnhäute. Sie tritt bei 5–10% aller Krebserkrankungen auf und führt häufig in wenigen Wochen zum Tode. Die frühzeitige Erkennung und Therapieeinleitung bergen die größte Chance auf eine längerfristige Symptomenkontrolle. Der Beitrag erläutert das klinische Erscheinungsbild einer Meningeosis neoplastica, die Wertigkeit verschiedener diagnostischer Maßnahmen und zeigt auf, wie bei der Erstellung individuell abgestimmter Therapiekonzepte vorzugehen ist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Bernardi RJ, Bomgaars L, Fox E et al (2008) Phase I clinical trial of intrathecal gemcitabine in patients with neoplastic menin-gitis. Cancer Chemother Pharmacol 62: 355–361

    Article  PubMed  CAS  Google Scholar 

  2. Blaney SM, Boyett J, Friedman H et al (2005) Phase I clinical trial of mafosfamide in infants and children aged 3 years or younger with newly diagnosed embryonal tumors: a pediatric brain tumor consortium study (PBTC-001). J Clin Oncol 23: 525–531

    Article  PubMed  CAS  Google Scholar 

  3. Bleyer WA, Griffin TW (1980) White matter necrosis, minerali-zing microangiopathy and intellectual abilities in survivors of childhood leukemia: associations with central nervous system irradiation and methotrexate therapy. In: Gilbert HA, Kagan AR (eds) Radiation damage to the nervous system, a delayed therapeutic hazard. Raven Press, New York, pp 155–174

  4. Boogerd W, Hart AAM, Sande JJ, Engelsman E (1991) Menin-geal carcinomatosis in breast cancer: prognostic factors and influence of treatment. Cancer 67: 1685–1695

    Article  PubMed  CAS  Google Scholar 

  5. Boogerd W, Vroom TM, van Heerde P et al (1988) CSF cytology versus immunocytochemistry in meningeal carcinomatosis. J Neurol Neurosurg Psychiatry 51: 142–145

    Article  PubMed  CAS  Google Scholar 

  6. Boogerd W, van den Bent MJ, Koehler PJ et al (2004) The rele-vance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study. Eur J Cancer 40: 2726–2733

    Article  PubMed  CAS  Google Scholar 

  7. Boogerd W, Dorresteijn LDA, van der Sande JJ et al (2000) Response of leptomeningeal metastases from breast cancer to hormonal therapy. Neurology 55: 117–119

    PubMed  CAS  Google Scholar 

  8. Bokstein F, Lossos A, Siegal T (1998) Leptomeningeal metas-tases from solid tumors: A comparison of two prospective series treated with and without intra-cerebrospinal fluid chemotherapy. Cancer 82: 1756–1763

    Article  PubMed  CAS  Google Scholar 

  9. Glantz MJ, Cole BF, Recht L et al (1998) High-dose intravenous methotrexate for patients with nonelukemic leptomeningeal cancer: Is intrathecal chemotherapy necessary? J Clin Oncol 16: 1561–1567

    PubMed  CAS  Google Scholar 

  10. Chamberlain MC, Kormanik P, Jaeckle KA et al (1999) 111Indi-um-diethylenetriamine pentaacetic acid CSF flow studies pre-dict distribution of intrathecally administered chemotherapy and outcome in patients with leptomeningeal metastases. Neurology 52: 216–217

    PubMed  CAS  Google Scholar 

  11. Chamberlain MC, Tsao-Wei D, Groshen S (2004) Neoplastic meningitis-related encephalopathy: prognostic significance. Neurology 63: 2159–2161

    PubMed  Google Scholar 

  12. Chamberlain MC (2005) Neoplastic meningitis. J Clin Oncol 23: 3605–3613

    Article  PubMed  Google Scholar 

  13. Chamberlain MC, Tsao-Wei DD, Groshen S (2006) Phase II trial of intracerebrospinal fluid etoposide in the treatment of neoplastic meningitis. Cancer 106: 2021–2027

    Article  PubMed  CAS  Google Scholar 

  14. Chamberlain MC (1998) Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol 38: 135–140

    Article  PubMed  CAS  Google Scholar 

  15. Chamberlain MC, Johnston SK, Glantz MJ (2009) Neoplastic meningitis-related prognostic significance of the Karnofsky performance status. Arch Neurol 66: 74–78

    Article  PubMed  Google Scholar 

  16. DeWit M, Lange-Brock V, Kruell A, Bokemeyer C (2007) Leptomeningeal metastases: results of different therapeutic approaches. J Clin Oncol 25: 86s (abstract)

    Google Scholar 

  17. Freilich RJ, Krol G, DeAngelis LM (1995) Neuroimaging and ce-rebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol 38: 51–57

    Article  PubMed  CAS  Google Scholar 

  18. Gaspar L, Scott C, Rotman M et al (1997) Recursive partitio-ning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37: 745–751

    PubMed  CAS  Google Scholar 

  19. Gammon DC, Bhatt MS, Tran L et al (2006) Intrathecal topote-can in adult patients with neoplastic meningitis. Am J Health Syst Pharm 63: 2083–2086

    Article  PubMed  CAS  Google Scholar 

  20. Glantz MJ, Jaeckle KA, Chamberlain MC et al (1999) A randomized controlled trial comparing intrathecal sustained-release cytarabine (DepoCyt) to intrathecal methotrexate in patients with neoplastic meningitis from solid tumors. Clin Cancer Res 5: 3394–3402

    PubMed  CAS  Google Scholar 

  21. Glas M, Stuplich M, Tschampa H et al (2008) Liposomal cytara-bine given concomitantly with radiotherapy in a patient with leptomeningeal metastasis from breast cancer. J Neurol 255: 1838–1839

    Article  PubMed  CAS  Google Scholar 

  22. Grossman SA, Finkelstein DM, Ruckdeschel JC et al (1993) Randomized prospective comparison of intraventricular me-thotrexate and thiotepa in patients with previously untreated neoplastic meningitis. J Clin Oncol 11: 561–569

    PubMed  CAS  Google Scholar 

  23. Groves MD, Glantz MJ, Chamberlain MC et al (2008) A multi-center phase II trial of intrathecal topotecan in patients with meningeal malignancies. Neuro-oncol 10: 208–215

    Article  PubMed  CAS  Google Scholar 

  24. Groves MD, Hess KR, Puduvalli VK et al (2009) Biomarkers of disease: cerebrospinal fluid vascular endothelial growth factor (VEGF) and stromal cell derived factor (SDF)-1 levels in patients with neoplastic meningitis (NM) due to breast can-cer, lung cancer and melanoma. J Neurooncol (Epub ahead of print)

  25. Herrlinger U, Förschler H, Küker W et al (2004) Leptomeninge-al metastasis: survival and prognostic factors in 155 patients. J Neurol Sci 223: 167–178

    Article  PubMed  Google Scholar 

  26. Herrlinger U, Wiendl H, Renninger M et al (2004) Vascular en-dothelial growth factor (VEGF) in leptomeningeal metastasis: diagnostic and prognostic value. Br J Cancer 91: 219–224

    PubMed  CAS  Google Scholar 

  27. Hilgendorf I, Wolff D, Junghanss C et al (2008) Neurological complications after intrathecal liposomal cytarabine appli-cation in patients after allogeneic haematopoietic stem cell transplantation. Ann Hematol 87: 1009–1012

    Article  PubMed  CAS  Google Scholar 

  28. Hitchins RN, Bell DR, Woods RL et al (1987) A prospective randomized trial of single-agent versus combination che-motherapy in meningeal carcinomatosis. J Clin Oncol 5: 1655–1662

    PubMed  CAS  Google Scholar 

  29. Jabbour E, O'Brien S, Kantarjian H et al (2007) Neurologic complications associated with intrathecal liposomal cytarabi-ne given prophylactically in combination with high-dose me-thotrexate and cytarabine to patients with acute lymphocytic leukaemia. Blood 109: 3214–3218

    Article  PubMed  CAS  Google Scholar 

  30. Jaeckle KA, Phuphanich S, Bent MJ et al (2001) Intrathecal treatment of neoplastic meningitis due to breast cancer with a slow-release formulation of cytarabine. Br J Cancer 84: 157–163

    Article  PubMed  CAS  Google Scholar 

  31. Jaeckle KA, Batchelor T, O‘Day SJ et al (2002) An open label trial of sustained-release cytarabine (DepoCyt) for the in-trathecal treatment of solid tumor neoplastic meningitis. J Neurooncol 57: 231–239

    Article  PubMed  Google Scholar 

  32. Kim S, Chatelut E, Kim JC et al (1993) Extended CSF cytarabine exposure following intrathecal administration of DTC 101. J Clin Oncol 11: 2186–2193

    PubMed  CAS  Google Scholar 

  33. Shapiro WR, Young DF, Mehta BM (1975) Methotrexate: Dis-tribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. N Engl J Med 293: 161–166

    PubMed  CAS  Google Scholar 

  34. Stockhammer G, Poewe W, Burgstaller S et al (2000) Vascular endothelial growth factor in CSF: A biological marker for car-cinomatous meningitis. Neurology 54: 1670–1676

    PubMed  CAS  Google Scholar 

  35. Wasserstrom WR, Glass JP, Posner JB (1982) Diagnosis and treatment of leptomeningeal metastases from solid tumors: Experience with 90 patients. Cancer 49: 759–772

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to U. Herrlinger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Herrlinger, U., Schüller, H. & Zipfell, M. Meningeosis neoplastica. best practice onkologie 4, 20–27 (2009). https://doi.org/10.1007/s11654-009-0148-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11654-009-0148-x

Navigation