This protocol applies to patients with type IA/C leptomeningeal metastasis: positive cerebrospinal fluid cytology (tumour cells in the CSF) or linear leptomeningeal disease on MRI.
Intra-CSF (intrathecal) pharmacotherapy was administered as the prior line but did not achieve complete CSF cytological response — defined as conversion of previously positive CSF cytology to negative, sustained for at least four weeks.
This protocol defines the next step following that failure.
The protocol involves a radiotherapy-based strategy, with the specific approach varying according to the extent and pattern of leptomeningeal involvement and patient prognosis.
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.
WBRT can be considered for extensive nodular or symptomatic linear LM.
Focal RT should be considered for circumscribed, notably symptomatic lesions.
Focal RT, given as involved-field hypofractionated stereotactic RT or stereotactic radiosurgery, is the consensual preferred option to treat nodular disease and symptomatic cerebral or spinal sites, notably in patients with favourable prognostic factors.
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