Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland, United States.
Neurologia (Engl Ed). 2022 Nov-Dec;37(9):794-805. doi: 10.1016/j.nrleng.2019.10.009. Epub 2021 Oct 15.
Neoplastic meningitis (NM) is a relatively frequent metastatic complication of cancer associated with high levels of neurological morbidity and generally poor prognosis. It appears in 5%-15% of patients with solid tumours, the most frequent being breast and lung cancer and melanoma. Symptoms are caused by involvement of the cerebral hemispheres, cranial nerves, spinal cord, and nerve roots, and are often multifocal or present with signs and symptoms of intracranial hypertension. The main diagnostic tools are the neurological examination, brain and spinal cord contrast-enhanced magnetic resonance imaging, and cerebrospinal fluid analysis including cytology, although studies have recently been conducted into the detection of tumour cells and DNA in the cerebrospinal fluid, which increases diagnostic sensitivity. With the currently available therapies, treatment aims not to cure the disease, but to delay and ameliorate the symptoms and to preserve quality of life. Treatment of NM involves a multimodal approach that may include radiotherapy, intrathecal and/or systemic chemotherapy, and surgery. Treatment should be individualised, and is based mainly on clinical practice guidelines and expert opinion. Promising clinical trials are currently being conducted to evaluate drugs with molecular and immunotherapeutic targets. This article is an updated review of NM epidemiology, clinical presentation, diagnosis, prognosis, management, and treatment; it is aimed at general neurologists and particularly at neurologists practicing in hospital settings with oncological patients.
癌性脑膜炎（neoplastic meningitis，NM）是癌症较为常见的一种转移并发症，与较高的神经发病率和普遍较差的预后相关。它出现在 5%-15%的实体瘤患者中，最常见的是乳腺癌、肺癌和黑色素瘤。症状是由大脑半球、颅神经、脊髓和神经根受累引起的，通常是多灶性的，或伴有颅内压升高的体征和症状。主要的诊断工具包括神经系统检查、脑和脊髓对比增强磁共振成像，以及包括细胞学在内的脑脊液分析，尽管最近已经开展了研究，以检测脑脊液中的肿瘤细胞和 DNA，这增加了诊断的敏感性。目前可采用的治疗方法旨在延缓和改善症状，以维持生活质量，而不是治愈疾病。NM 的治疗包括多模式方法，可能包括放疗、鞘内和/或全身化疗和手术。治疗应个体化，并主要基于临床实践指南和专家意见。目前正在进行有前途的临床试验，以评估具有分子和免疫治疗靶点的药物。本文是对 NM 的流行病学、临床表现、诊断、预后、管理和治疗的更新综述；目的是为一般神经科医生，特别是在有肿瘤患者的医院环境中执业的神经科医生提供参考。
