1.Diagnosis of leptomeningeal metastases (LM).
1.1 Clinical symptoms: Neurological symptoms vary widely, ranging from mild to severe, localized, extensive, or without obvious neurological symptoms, depending on the functional area involved. Typical clinical manifestations include intracranial hypertension (headache, nausea, and vomiting), hydrocephalus (cognitive decline, gait abnormalities, and urinary incontinence).Cranial nerve palsies, especially with diplopia or visual disturbances (cranial nerves II, III, IV, VI), facial palsy (cranial nerve VII), and hearing loss (cranial nerve VIII);Radiculologic symptoms include lower extremity five forces, muscle weakness;and focal or radial (radicular) neck and back pain.
1.2 Imaging findings: linear LM (type A), nodular LM (type B), both, and both of which exceed 20% of the tumor burden (type C), hydrocephalus only (hydrocephalus type D), and no meningeal abnormalities on suspicious or MRI (normal type D).
Definition of nodular leptomeningeal metastases: on T1-enhanced MRI, if the nodule margin is < 2 mm away from the leptomeninges, and the nodule is enhanced.
Measurable nodular leptomeningeal metastases: a nodule is considered measurable if the product of the vertical diameter of the nodule in both planes is 5 mm 5 mm.
1.3 Cerebrospinal fluid cytology leptenoid histopathology: preferably more than 10ml, fixed within 30min. To avoid false positives, it is recommended that the brain surgery be performed 14 days after the puncture. Cerebrospinal fluid reports are divided into: positive, suspiciously positive atypical cells, negative.
Diagnostic criteria: Based on cerebrospinal fluid cytology and meningeal biopsy histopathology, comprehensive consideration of imaging features, clinical manifestations, and history of malignancy.
At present, there are few clinical trials on leptomeningeal metastases, which are mainly expert consensus, and the level of evidence is not high.
2.1 Whole body**: The following require the whole body**, including chemotherapy, targeting** and immunization**, etc.:
1.There are also tumor foci in the brain parenchyma or outside the brain
2.Nodular meningeal metastases
3.Intravenous drugs can reach cerebrospinal fluid, such as osimertinib**EGFR mutant lung adenocarcinoma brain metastases, ceritinib**ALK-positive lung adenocarcinoma, or the use of high-dose methotrexate (MTX), celtipa, and other drugs that can enter the cerebrospinal fluid.
2.2. Cerebrospinal fluid chemotherapy: suitable for patients with ependymal and meningeal metastases, not for patients with obstructed cerebrospinal fluid circulation (such as obstructive hydrocephalus).
1.Route of administration: intraventricular administration (eg, omaya sac) and subarachnoid administration (eg, lumbar puncture intrathecal), the former is recommended.
2.Drug selection: Commonly used drugs are: MTX, cytarabine, setepa, pemetrexed, and nivolumab, trastuzumab monoclonal antibody, topotecan, etc. There is no conclusive or consensus on how to choose drugs, and the combination of drugs does not increase the efficacy. It is preliminarily believed that the safety of the setepa exceeds that of MTX. **Duration is also inconclusive or consensus, and is often progressive, intolerant, or discontinuation of cerebrospinal fluid chemotherapy for more than 1 year.
2.3. Radiotherapy: There are no clinical trials exploring the safety and efficacy of radiotherapy in patients with meningeal metastases.
1.Local radiotherapy, i.e., hypofractionated stereotactic radiosurgery or stereotactic radiosurgery of the affected area, is recommended for nodular meningeal metastases and symptomatic brain or spinal metastases, especially in patients with a good prognosis.
2.Whole-brain radiotherapy: Whole-brain radiotherapy is used as a palliative treatment in patients with extensive nodular or symptomatic linear meningeal metastases or with parenchymal brain metastases.
3.*Assess.
Evaluation of the efficacy of meningeal metastases** requires a combination of neurological symptoms, imaging, and cerebrospinal fluid cytology. The effect of EANO-ESMO meningeal metastases** was assessed using the RANO criteria (2017 edition). The disadvantage is that the imaging evaluation criteria in the RANO criteria are complex and difficult to use clinically, and the EANO-ESMO version is avoided and ignored.
Metastases.