Pial metastasis is a relatively rare but serious complication in cancer patients, such as breast, lung and melanoma, gastrointestinal tumors, kidney cancer, etc. As patients with advanced cancer live longer, the incidence of leptomeningeal metastases is also increasing, especially in advanced (stage IV) cancer patients (EGFR-mutant lung adenocarcinoma is the most common occur frequently).
Signs of leptomeningeal metastases
Signs and symptoms of metastases may include:
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Rhizopathies
Rhizopathies can affect the roots of the spinal nerves and occur from the neck (cervical spine) to the lower spine (lumbar spine) ) anywhere. Injury to the spinal nerve roots, such as compression, often produces symptoms in other areas. For example, compression of nerve roots in the neck can cause arm pain, numbness, tingling in addition to neck pain and/or powerless.
With compression of the spinal nerve roots in the lumbar region (also known as sciatica), patients may experience not only back pain, but also numbness and weakness in one or both legs , there is usually an electrical sensation moving down the leg.
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Cranial nerve palsy
Involvement of the cranial nerves can cause different symptoms, depending on the specific cranial nerves or affected nerves. Perhaps the most famous cranial nerve palsy is Bell’s palsy, a condition that causes one side of the face to droop.
Symptoms that may appear based on cranial nerve involvement include:
olfactory nerve: changes in the sense of smell and taste;
optic nerve: vision changes or blindness;
oculomotor nerve: the pupil does not constrict under strong light, and the upper eyelid is difficult to move;
trochlear nerve: diplopia;
trigeminal nerve: facial pain;
abductor: diplopia (sixth nerve palsy);
facial nerve: facial muscle weakness;
vestibular cochlea: hearing loss and vertigo;
Glossopharyngeal: hearing loss and vertigo;
vagus nerve: difficulty swallowing and/or speaking;
spinal appendage: shoulder weakness;
hypoglossal nerve : Difficulty speaking due to difficulty moving the tongue.
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Brain disorders
This may include disordered thinking , Personality changes, Memory loss, Difficulty concentrating, Drowsiness, and in severe cases, loss of consciousness.
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Intracranial pressure increased
CSF flow obstruction can result in leptomeningeal metastases lead to increased intracranial pressure. Symptoms include headache, vomiting (usually without nausea), behavioral changes, somnolence, and loss of consciousness< /strong>. Other neurological symptoms may also occur, depending on the location of the blockage.
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Threat of stroke
Cancer cells in the cerebrospinal fluid may also block or compress blood vessels in the brain , causing a stroke. Symptoms depend on the specific part of the brain affected and may include visual changes, language changes, loss of balance or coordination, or unilateral Powerless.
Treatment of leptomeningeal metastases
Treatment of leptomeningeal metastases depends on many factors, including the severity of symptoms, the type of primary cancer, the person’s general health, other presence of metastases, etc.
These treatment options may be included in addition to steroid drugs often used to control swelling in the brain.
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Radiation therapy
Radiation therapy (or proton beam therapy)< /strong>It is the most rapid and effective method for the treatment of leptomeningeal metastasis. In most cases, fractionated external beam radiation is directed directly at the area where the cancer cell clusters are causing symptoms.
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intracerebroventricular chemotherapy
because of intravenous chemotherapy
strong>Does not normally cross the blood-brain barrier, so is usually injected directly into the cerebrospinal fluid. This is called intraventricular, cerebrospinal fluid, or intrathecal chemotherapy.
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Systemic therapy
Controlling cancer in other parts of the body is also important, so clinical Doctors often use additional treatments along with intrathecal chemotherapy and/or radiation therapy.
Some systemic treatments can penetrate the blood-brain barrier and help leptomeningeal metastasis. For lung cancer, some EGFR inhibitors and ALK inhibitors breach the blood-brain barrier and may help treat these metastases.
For melanoma, BRAF inhibitors such as vemurafenib, dabrafenib, and connefenib may be helpful. For a variety of cancers, immunotherapy drugs have also shown promise in treating tumors that have spread to the brain or pia mater. Immunotherapy checkpoint inhibitor Nivolumab and ipilimumab showed improved survival when taken together in patients with melanoma and leptomeningeal metastases.
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Intrathecal Targeted Therapy
For HER2-positive breast cancer, targeted drugs Trastuzumab (Herceptin) can be administered intrathecally (a route of administration in which the drug is injected into the spinal canal or into the subarachnoid space to reach the cerebrospinal fluid).
[Important Notice]The information in the article is for reference only, and the specific treatment follow the doctor’s advice!