Meningeosis neoplastica

Zusammenfassung

Die Meningeosis neoplastica tritt bei bis zu 10 % aller Patienten mit malignen Tumoren im Verlauf der Erkrankung auf. Unter den soliden Tumoren metastasieren Bronchialkarzinome, Mammakarzinome und maligne Melanome am häufigsten in den Liquorraum. Die Meningeosis neoplastica ist zudem eine häufige Komplikation bei lymphohämatopoietischen Neoplasien. Die Tumorzellaussaat erfolgt in Form solider Absiedlungen mit Anschluss an die Blutzirkulation oder in Form einer diffusen Ausbreitung nichtadhärent wachsender Tumorzellen im Liquorraum oder in Form einer Kombination beider Metastasierungstypen. Die Form des Metastasierungstyps sowie die Ab- oder Anwesenheit zusätzlicher solider Hirnmetastasen oder extrazerebraler Metastasen bestimmt, in welcher Form Strahlentherapie, systemische Chemotherapie und intrathekale Chemotherapie kombiniert werden. Die kombinierte Chemoradiotherapie verlängert das mediane Überleben von 6 - 8 Wochen auf 2 - 8 Monate und führt zu einem 1-Jahres-Überleben von 5 - 25 %. Die Komplexität des Krankheitsbilds erfordert ein individualisiertes therapeutisches Vorgehen unter besonderer Berücksichtigung der Beeinträchtigung der Lebensqualität durch die therapeutischen Maßnahmen.

Leptomeningeal Metastases

Leptomeningeal metastasis may develop in up to 10 % of cancer patients in the course of their disease. Among solid tumors, lung and breast cancer and malignant melanoma most often seed in the subarachnoid space. Leptomeningeal seeding is also common in lymphoid and hematological neoplasias. Cancer cells may grow as solid leptomeningeal lesions and carry their own blood supply, or may assume a floating type pattern of metastatic disease in the cerebrospinal fluid space, or both. These growth patterns, as well as the absence or presence of solid brain metastases and systemic metastases, determine how the major treatment modalities, radiotherapy and systemic and intrathecal chemotherapy, are best combined. Combined modality treatment prolongs the median survival from 6 - 8 weeks to 2 - 8 months, for a one year survival rate of 5 - 25 %. The complexity of this complication of systemic cancer requires the development of individualized treatment strategies which consider the impact of the therapeutic measures on the quality of life.

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