Leptomeningeal Disease: Current Approaches and Future Directions.

IF 5.2 2区医学 Q1 CLINICAL NEUROLOGY Current Neurology and Neuroscience Reports Pub Date : 2025-03-18 DOI:10.1007/s11910-025-01412-y

Ugur Sener, Jessica A Wilcox, Adrienne A Boire

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Abstract

Purpose of review: Leptomeningeal disease (LMD), or spread of cancer cells into the pia and arachnoid membranes encasing the brain and spinal cord, is associated with high symptom burden and poor survival at 2 to 5 months. Conventional treatments including photon-based radiation therapy, systemic chemotherapy, and intrathecal chemotherapy demonstrate limited efficacy. Despite significant successes for a range of solid tumors, immunotherapy has not yet demonstrated significant efficacy in management of LMD. Advances in understanding of LMD pathophysiology, improved diagnostics, and novel therapeutics are shifting this paradigm. In this article, we review diagnostic and treatment challenges associated with LMD.

Recent findings: We discuss the use of novel cerebrospinal fluid (CSF) analysis techniques such as circulating tumor cell and CSF cell-free DNA assessment to overcome limitations of conventional diagnostic modalities. We then review advances in treatment including clinical trial data demonstrating efficacy of proton craniospinal radiation to treat the entire neuroaxis. We discuss emerging data regarding targeted therapeutics conferring durable survival benefit. Novel therapeutics and combinatorial treatment approaches will likely further improve outcomes for patients with LMD.

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轻脑膜疾病：目前的方法和未来的方向。

回顾目的：轻脑膜疾病（LMD），或癌细胞扩散到包裹大脑和脊髓的网膜和蛛网膜，与高症状负担和2至5个月生存率低相关。常规治疗包括光子放射治疗、全身化疗和鞘内化疗的疗效有限。尽管免疫疗法在一系列实体瘤中取得了显著的成功，但在LMD的治疗中尚未显示出显著的疗效。对LMD病理生理学的理解的进步、诊断的改进和新的治疗方法正在改变这一范式。在本文中，我们回顾了与LMD相关的诊断和治疗挑战。最近的发现：我们讨论了使用新的脑脊液（CSF）分析技术，如循环肿瘤细胞和CSF无细胞DNA评估，以克服传统诊断方式的局限性。然后我们回顾了治疗的进展，包括临床试验数据，证明质子颅脊髓放射治疗整个神经轴的疗效。我们讨论有关靶向治疗的新数据，赋予持久的生存效益。新的治疗方法和联合治疗方法可能会进一步改善LMD患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Neurology and Neuroscience Reports 医学-临床神经学

CiteScore

9.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Neurology and Neuroscience Reports provides in-depth review articles contributed by international experts on the most significant developments in the field. By presenting clear, insightful, balanced reviews that emphasize recently published papers of major importance, the journal elucidates current and emerging approaches to the diagnosis, treatment, management, and prevention of neurological disease and disorders. Presents the views of experts on current advances in neurology and neuroscience Gathers and synthesizes important recent papers on the topic Includes reviews of recently published clinical trials, valuable web sites, and commentaries from well-known figures in the field.

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