Version June 2024
Treatment of LMD involves complex care coordination, potential for severely morbid disease and treatment complications, incorporation of novel targeted therapies, frequent assessment of an often dynamic process, and thoughtful balancing of symptom relief with the principles of self-determination.
The schema presented is an overview of treatment options with an approximate hierarchy and sequence, which may not fit all clinical scenarios. Refer to UpToDate topic review on treatment of LMD from solid tumors for more detail.IV: intravenous; CSF: cerebrospinal fluid; LMD: leptomeningeal disease; CNS: central nervous system; HER2: human epidermal growth factor receptor 2.
* In some cases, urgent management of severe hydrocephalus may not allow time for RT. In mild cases, radiation can lead to symptom resolution and forestall or avoid shunting.
¶ Control of both the CNS and systemic disease may require multiple agents, although many newer therapies have demonstrated dual CNS and systemic activity. If such a treatment option exists for a patient, systemic therapy is generally given rather than, or in rare cases along with, IT therapy.
Δ The best candidates for IT therapy are those with linear, nonbulky LMD; no hydrocephalus; and absent brain metastases.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
