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Recent Advancements of Treatment for Leptomeningeal Carcinomatosis
Treatment of Leptomeningeal carcinomatosis (LMC) from solid cancers has not advanced noticeably since the introduction of intra-cerebrospinal fluid (CSF) chemotherapy in the 1970's. The marginal survival benefit and difficulty of intrathecal chemotherapy injection has hindered its wide spread u...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Neurosurgical Society
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534733/ https://www.ncbi.nlm.nih.gov/pubmed/26279806 http://dx.doi.org/10.3340/jkns.2015.58.1.1 |
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author | Gwak, Ho-Shin Lee, Sang Hyun Park, Weon Seo Shin, Sang Hoon Yoo, Heon Lee, Seung Hoon |
author_facet | Gwak, Ho-Shin Lee, Sang Hyun Park, Weon Seo Shin, Sang Hoon Yoo, Heon Lee, Seung Hoon |
author_sort | Gwak, Ho-Shin |
collection | PubMed |
description | Treatment of Leptomeningeal carcinomatosis (LMC) from solid cancers has not advanced noticeably since the introduction of intra-cerebrospinal fluid (CSF) chemotherapy in the 1970's. The marginal survival benefit and difficulty of intrathecal chemotherapy injection has hindered its wide spread use. Even after the introduction of intraventricular chemotherapy with Ommaya reservoir, frequent development of CSF flow disturbance, manifested as increased intracranial pressure (ICP), made injected drug to be distributed unevenly and thus, the therapy became ineffective. Systemic chemotherapy for LMC has been limited as effective CSF concentration can hardly be achieved except high dose methotrexate (MTX) intravenous administration. However, the introduction of small molecular weight target inhibitors for primary cancer treatment has changed the old concept of 'blood-brain barrier' as the ultimate barrier to systemically administered drugs. Conventional oral administration achieves an effective concentration at the nanomolar level. Furthermore, many studies report that a combined treatment of target inhibitor and intra-CSF chemotherapy significantly prolongs patient survival. Ventriculolumbar perfusion (VLP) chemotherapy has sought to increase drug delivery to the subarachnoid CSF space even in patients with disturbed CSF flow. Recently authors performed phase 1 and 2 clinical trial of VLP chemotherapy with MTX, and 3/4th of patients with increased ICP got controlled ICP and the survival was prolonged. Further trials are required with newly available drugs for CSF chemotherapy. Additionally, new LMC biologic/pharmacodynamic markers for early diagnosis and monitoring of the treatment response are to be identified with the help of advanced molecular biology techniques. |
format | Online Article Text |
id | pubmed-4534733 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | The Korean Neurosurgical Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-45347332015-08-16 Recent Advancements of Treatment for Leptomeningeal Carcinomatosis Gwak, Ho-Shin Lee, Sang Hyun Park, Weon Seo Shin, Sang Hoon Yoo, Heon Lee, Seung Hoon J Korean Neurosurg Soc Review Article Treatment of Leptomeningeal carcinomatosis (LMC) from solid cancers has not advanced noticeably since the introduction of intra-cerebrospinal fluid (CSF) chemotherapy in the 1970's. The marginal survival benefit and difficulty of intrathecal chemotherapy injection has hindered its wide spread use. Even after the introduction of intraventricular chemotherapy with Ommaya reservoir, frequent development of CSF flow disturbance, manifested as increased intracranial pressure (ICP), made injected drug to be distributed unevenly and thus, the therapy became ineffective. Systemic chemotherapy for LMC has been limited as effective CSF concentration can hardly be achieved except high dose methotrexate (MTX) intravenous administration. However, the introduction of small molecular weight target inhibitors for primary cancer treatment has changed the old concept of 'blood-brain barrier' as the ultimate barrier to systemically administered drugs. Conventional oral administration achieves an effective concentration at the nanomolar level. Furthermore, many studies report that a combined treatment of target inhibitor and intra-CSF chemotherapy significantly prolongs patient survival. Ventriculolumbar perfusion (VLP) chemotherapy has sought to increase drug delivery to the subarachnoid CSF space even in patients with disturbed CSF flow. Recently authors performed phase 1 and 2 clinical trial of VLP chemotherapy with MTX, and 3/4th of patients with increased ICP got controlled ICP and the survival was prolonged. Further trials are required with newly available drugs for CSF chemotherapy. Additionally, new LMC biologic/pharmacodynamic markers for early diagnosis and monitoring of the treatment response are to be identified with the help of advanced molecular biology techniques. The Korean Neurosurgical Society 2015-07 2015-07-31 /pmc/articles/PMC4534733/ /pubmed/26279806 http://dx.doi.org/10.3340/jkns.2015.58.1.1 Text en Copyright © 2015 The Korean Neurosurgical Society http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Article Gwak, Ho-Shin Lee, Sang Hyun Park, Weon Seo Shin, Sang Hoon Yoo, Heon Lee, Seung Hoon Recent Advancements of Treatment for Leptomeningeal Carcinomatosis |
title | Recent Advancements of Treatment for Leptomeningeal Carcinomatosis |
title_full | Recent Advancements of Treatment for Leptomeningeal Carcinomatosis |
title_fullStr | Recent Advancements of Treatment for Leptomeningeal Carcinomatosis |
title_full_unstemmed | Recent Advancements of Treatment for Leptomeningeal Carcinomatosis |
title_short | Recent Advancements of Treatment for Leptomeningeal Carcinomatosis |
title_sort | recent advancements of treatment for leptomeningeal carcinomatosis |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534733/ https://www.ncbi.nlm.nih.gov/pubmed/26279806 http://dx.doi.org/10.3340/jkns.2015.58.1.1 |
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