What is Leptomeningeal Metastases : Causes, Symptoms, Treatment, Outlook, Diagnosis

Leptomeningeal metastases occur when the cancer cells metastasize to the meninges, cerebral spinal fluid, or both.

Meninges are the thin layers of tissue that surround and protect the spinal cord and brain. Cerebrospinal fluid is a clear liquid that is produced by the brain and appears between the layers of the meninges. It provides a cushion for the spinal cord and brain. The symptoms of leptomeningeal metastases occur due to the clogging of the usual exit points of cerebrospinal fluid.

According to research, 5-10% of people with cancer develop leptomeningeal metastases.⁽¹⁾ It is more common in those with breast, lung, and skin cancer.

According to the National Cancer Institute, leptomeningeal metastases is a serious condition and results in inflammation of the meninges.⁽²⁾

Leptomeningeal metastases is also known as neoplastic meningitis, leptomeningeal disease, leptomeningeal carcinomatosis, and carcinomatous meningitis.

It is observed that around 5-8% of people with solid cancer tumors and 5-15% of people with hematological and blood cancer develop leptomeningeal metastases.⁽³⁾

Leptomeningeal metastases occur when the cancer cells spread. In this condition, the cancerous cells travel from another part of the body through the bloodstream and reach the cerebrospinal fluid.

Most solid tumors metastasize, but the most common ones include breast tumors, lung tumors, melanoma, gastrointestinal tumors, and primary central nervous system tumors.⁽³⁾

Despite being fairly rare, leptomeningeal metastases is the third most common type of metastases cancer.⁽⁴⁾

The largest risk factor for developing leptomeningeal metastases is a person suffering from cancer.

The symptoms of leptomeningeal metastases occur as the cancerous cells start affecting the flow of nutrients or putting pressure on the spinal cord. Also, many people have no symptoms at all.

Common symptoms of leptomeningeal metastases include:

• Weakness
• Confusion
• Seizures
• Nausea and vomiting
• Hearing problems
• Facial drooping
• Changes in behavior or mood
• Problems with bowel or bladder control
• Loss of sight or double vision
• Pain in the neck, leg, or lower back
• Weakness or numbness in the bottom or one or both the legs

The diagnosis of leptomeningeal metastases can be very challenging. It can be diagnosed with the help of an imaging test such MRI. Diagnosis can also be made by looking for cancerous cells in the cerebrospinal fluid. A lumbar puncture is performed and the fluid is taken from the lower back.

Usually, leptomeningeal metastases occur 1.2-2 years after someone receives a cancer diagnosis.

The treatment of leptomeningeal metastases depends on the individual and whether it developed from a primary or secondary cancer.

The various treatments for leptomeningeal metastases include:

• Chemotherapy: It involves anticancer medications in the form of oral medications or injections into the vein or injections directly into the cerebrospinal fluid.
• Radiation Therapy: It involves the delivery of radiation in the form of x-rays to the whole part of the brain to shrink or eliminate cancer cells.
• Targeted Cancer Medications: Specific types of medication are provided depending on the type of cancer
• Surgery: Surgery can be helpful in improving the flow of cerebrospinal fluid and reducing the pressure on the brain and meninges. However, it is rarely performed.

The outlook of leptomeningeal metastases depends on individual factors, which include:

• Whether the cancer cells have migrated to additional parts of the body
• How cancer responded to the treatment
• How fast the cancer is spreading

Even with the treatment, a person may survive for around 2-4 months.⁽³⁾ People getting leptomeningeal metastases due to breast cancer live for a little longer compared with people developing it after lung cancer.

The only way to prevent leptomeningeal metastases is to effectively treat the primary and secondary cancer before it spreads. Diagnosing and treating leptomeningeal metastases can be challenging and the outlook is limited even with proper treatment. The treatment aims at improving the quality of life of an individual.