Treatment of Leptomeningeal Carcinomatosis with Tumour Cells in the Cerebrospinal Fluid (Positive CSF Cytology)

Clinical Scenario

This protocol addresses leptomeningeal carcinomatosis in patients with confirmed tumour cells in the cerebrospinal fluid (positive CSF cytology) or with linear leptomeningeal disease on MRI — corresponding to type IA/C leptomeningeal metastasis.

Qualifying Findings

Intrathecal therapy is indicated when tumour cells are detected in the CSF or when linear leptomeningeal enhancement is evident on neuroimaging. Both findings — cytological and radiological — define this specific treatment indication.

Treatment Approach

Management involves intra-CSF (intrathecal) pharmacotherapy delivered via the ventricular route, using established chemotherapeutic agents given on a structured maintenance schedule.

Agent selection, full dosing schedule, and supportive measures are detailed in the complete protocol.

Treatment Goal

The primary objective is a complete CSF cytological response — conversion of previously positive CSF cytology to negative, maintained for at least four weeks.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.esmoop.2023.101624

Intra-CSF pharmacotherapy should be considered for patients with type IA/C LM.

Intrathecal therapy should be considered in the presence of tumour cells in the CSF or in the presence of linear LM.

Intra-CSF ChT should be administered via the ventricular rather than lumbar route whenever feasible.

A complete CSF cytological response requires a conversion of a previously positive to a negative CSF response maintained for at least 4 weeks.

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