An overview of leptomeningeal disease

: Leptomeningeal disease (LMD) is a poor prognosis pattern of progression in patients with metastatic malignancy limited treatment options. Patients may be asymptomatic or present non-specific neurologic deficits, therefore gadolinium-enhanced magnetic resonance imaging the brain and spine critical for establishing diagnosis. Although intent palliative context LMD, multidisciplinary approach still important to ensure receive timely diagnosis appropriate maximize symptom control preserve quality life. Radiotherapy typically delivered whole focal spinal regions purposes treating bulky disease, stabilizing symptoms, relieving cerebrospinal fluid obstruction. Whole craniospinal irradiation (CSI) generally avoided given its toxicity profile should only considered carefully selected where potential benefit outweigh adverse effects. CSI proton radiotherapy (oppose conventional photon radiotherapy) has shown promise improved primary CNS tumors. This preferred option being at centres therapy capabilities. Focal hypofractionated stereotactic (SRT) intracranial targets an emerging LMD that useful select particularly setting reirradiation. Chemotherapies intrathecally, although evidence supporting efficacy heterogeneous regards tumor sites examined. Finally, targeted novel applications immune checkpoint inhibitors are promising; however, further research required guide use these agents.