Leptomeningeal disease in palliative care
Leptomeningeal disease is the direct invasion of cancer into central neuronal tracts or the meninges. It occurs most commonly in patients with palliative care needs who have lung, melanoma or breast cancerFigura, 2019Le Rhun, 2017. Common features of leptomeningeal disease are:
- headache
- nausea and vomiting
- mental status changes (eg delirium)
- gait disturbance
- cranial nerve palsies
- radiculopathy
- seizures
- raised intracranial pressure.
Diagnosis of leptomeningeal disease is often by exclusion; investigations such as computed tomography (CT) and magnetic resonance imaging (MRI) may not reveal abnormalities. Lumbar puncture may confirm the diagnosis but should only be undertaken if diagnosis is likely to influence management.
Leptomeningeal disease indicates advanced cancer and a poor prognosis (6 to 8 weeks without tumour-specific treatment)—review the patient’s goals of care. Some patients benefit from palliative radiotherapy, or systemic or intrathecal anticancer therapy, depending on their goals of care and preferences. The role of corticosteroids has not been specifically studied in patients with leptomeningeal disease; however, corticosteroid therapy may reduce meningeal irritation and radicular pain—see Corticosteroids for raised intracranial pressure due to brain cancer in palliative care for dose regimensLe Rhun, 2017.