AbstractLeptomeningeal metastasis i

AbstractLeptomeningeal metastasis is an uncommon and typically late complication of cancer with poor prognosis and limited treatment options. Diagnosis is often challenging with nonspecific presenting symptoms ranging from headache and confusion to focal neurologic deficits such as cranial nerve palsies. Standard diagnostic evaluation involves a neurologic examination, MRI of the brain and spine with gadolinium, and cytologic evaluation of the cerebral spinal fluid (CSF). Therapy entails a multimodal approach focused on palliation with surgery, radiation, and/or chemotherapy, which may be administered systemically or directly into the CSF. Limited trial data exists to guide treatment, with current regimens based primarily on expert opinion. Although newer targeted and immunotherapeutic agents are under investigation and show promise, an improved understanding of the biology of leptomeningeal metastasis and treatment resistance, as well as additional randomized controlled studies, are needed to guide optimal treatment of this devastating disease.