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Meningeosis neoplastica

Epidemiologie, Diagnostik und Therapie

Neoplastic meningitis

Epidemiology, diagnosis and treatment

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Meningeosis neoplastica beschreibt den diffusen Befall des Liquorsystems mit Tumorzellen. Sie ist in der Häufigkeit deutlich unterschätzt, kann bei fast allen Tumorerkrankungen auftreten und bedeutet oftmals eine infauste Prognose. Jedoch belegen zahlreiche Beispiele, dass Patient*innen durch einen geeigneten Therapieansatz eine Lebensverlängerung bei guter Lebensqualität ermöglicht werden konnte.

Fragestellung

Der Artikel gibt eine Übersicht über Diagnostik und Therapie der Meningeosis.

Material und Methoden

Dazu wurden neuere und ältere Literatur sowie Teile der Leitlinie zusammengefasst.

Ergebnisse

Körperliche Untersuchung, Liquorpunktion und bildmorphologische Darstellung des zentralen Nervensystems führen zur Sicherung der Diagnose und Bestimmung der Läsionslast. Dem Komplementsystem scheint eine bislang nicht bekannte Rolle bei der Entstehung der Meningeosis zuzukommen. Als Therapieoptionen stehen Radiotherapie und systemische bzw. intrathekale Chemotherapie zur Verfügung. Symptomatische Optionen wie das Einsetzen eines ventrikuloperitonealen Shunts und eine zusätzliche Dexamethasontherapie sind ggf. zu erwägen. Intrathekal werden Cytarabin, Methotrexat und Thiotepa ohne signifikante Wirksamkeitsnachweise eingesetzt. Immuntherapeutische oder molekular zielgerichtete intrathekale Ansätze, z. B. mit Osimertinib, Lorlatinib, Alectinib, Trastuzumab-Emtansin und Nivolumab plus Ipilimumab werden nun, je nach molekularem Profil des Primärtumors, vermehrt diskutiert.

Schlussfolgerung

Die Meningeosis neoplastica ist schwer zu behandeln. Neuere Ansätze geben Grund zur Hoffnung, die Lebensqualität und -quantität zu verbessern, benötigen aber noch Wirkungsnachweise aus klinischen Studien.

Abstract

Background

Neoplastic meningitis describes diffuse subarachnoidal dissemination of tumor cells. The frequency of neoplastic meningitis is underestimated, and it can occur in almost any tumor entity. Often, neoplastic meningitis is associated with a very poor prognosis. However, numerous examples show that patients can benefit from well-planned therapy in terms of improved quality and quantity of life.

Objective

An overview of diagnostic and therapeutic options in the management of neoplastic meningitis is provided.

Materials and methods

The results of a MEDLINE search and the German guidelines are summarized.

Results

For diagnostic confirmation of neoplastic meningitis, a physical examination, analysis of cerebrospinal fluid and magnet resonance imaging are recommended. Pathophysiologically, new preclinical approaches like the involvement of the complement system in meningeosis development are promising. As causal therapy, approaches like radiotherapy, systemic chemotherapy and intrathecal chemotherapy are available. Symptomatic treatment options, e.g., implantation of a ventriculoperitoneal shunt or a systemic treatment with dexamethasone, are also available. The most common substances that have been used intrathecally for many years include cytarabine, methotrexate, and thiotepa, but without significant proof of efficacy. New substances targeting molecular alterations are increasingly discussed. Depending on the molecular profile of the primary tumor, osimertinib, lorlatinib, alectinib, trastuzumab-emtansine and the combination of nivolumab and ipilimumab are CNS-effective substances of interest for example.

Conclusion

Neoplastic meningitis remains a challenging entity. Newer approaches give hope to improve patients’ quality of life but further research regarding efficacy from clinical trials is needed.

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Authors and Affiliations

  1. Klinik für Neurologie, Abteilung Klinische Neuroonkologie, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland

    C. Oster,  S. Kebir &  M. Glas

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  1. C. Oster
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  2. S. Kebir
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  3. M. Glas
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Correspondence to C. Oster.

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Interessenkonflikt

S. Kebir gibt an, Vortragshonorare und finanzielle Reiseunterstützung von Novocure, Merck und Roche erhalten zu haben. M. Glas gibt Honoraria von Novartis, Merck, Novocure, medac, Kyowa Kirin und UCB an; sowie Reisekostenunterstützung von medac und Novocure, und ist beratend für Roche, Novartis, Daiichi Sankyo, Novocure, Bayer und Janssen-Cilag tätig. C. Oster gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Oster, C., Kebir, S. & Glas, M. Meningeosis neoplastica. Onkologe 28, 395–404 (2022). https://doi.org/10.1007/s00761-021-01073-9

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