Leptomeningeal Metastases and Intrathecal Chemotherapy

Leptomeningeal metastases (LM) is a rare but devastating complication of advanced cancer. Advances in cancer treatment has markedly improved the survival, nonetheless, due to the poor penetration of these treatments beyond the blood-brain and blood-CSF barrier for most modalities, creating a sanctuary site in the CNS/CSF space for the disease, and reflecting as increased incidence of LM. Whereas the goal of LM treatment remains to be symptom palliation and not elongation of survival, the optimal treatment, and whom to treat remains to be somewhat controversial. Herein we review the advances in LM treatment focusing on the role of intrathecal chemotherapy.