Treatment Options
Currently, there is no standard of care protocol for treating leptomeningeal cancer, meaning there isn’t an agreed upon way to treat leptomeningeal cancer. The goals of treatment are to reduce or stabilize symptoms, improve quality of life, and prolong survival with as few side effects as possible. It’s important to note:
- Every person responds differently to treatment. And some may not respond at all.
- Treatment options may depend on a number of factors, including the type of cancer, genetic mutations (changes) in the tumor cells, previous treatments, the amount of disease present, and your overall state of health.
- Treatment requires a multidisciplinary approach, meaning many healthcare providers from different specialties should be involved in your care.
- Deciding to receive treatment is a personal choice. Discuss with your doctor so you can determine together what path is right for you.
Options for treatment may include:
- Systemic therapy: Systemic therapies work to treat cancer throughout the body. Some of these can enter into the central nervous system to treat leptomeningeal cancer. These can be given intravenously (through an IV) or orally. Systemic treatments include chemotherapy, hormone therapy, targeted therapy, and immunotherapy.
- Intrathecal therapy: Intrathecal therapies are treatments that are injected directly into the CSF. This is done through a lumbar puncture or an Ommaya reservoir. Intrathecal therapies work better in patients with floating cells or a thin layer of cancer cells, as opposed to bulky and nodular tumors or masses. Intrathecal therapies do not work well to treat tumors deep inside the brain and spinal cord.
- Radiation: Conventional radiation treatment (whole brain radiation or targeted/focal radiation to the brain or spine) for leptomeningeal cancer is generally considered palliative. This means that it can prevent or treat symptoms to improve quality of life, but may not improve survival. Radiation to the brain and spine together (craniospinal irradiation, or CSI) can improve survival, but may not be appropriate for all patients.
- Surgical interventions:
- Ommaya reservoirs or ports are small, dome-shaped devices (about the size of a quarter) that are surgically inserted under the scalp to deliver intrathecal treatment. The Ommaya can also be used to remove CSF samples for testing.
- Ommaya reservoirs or ports are small, dome-shaped devices (about the size of a quarter) that are surgically inserted under the scalp to deliver intrathecal treatment. The Ommaya can also be used to remove CSF samples for testing.
- A ventriculoperitoneal shunt, also known as a VP shunt, is a small tube that is surgically inserted in a space in the brain. Excess CSF is drained from the brain into the abdomen through the thin tube. This can relieve symptoms of high pressure in the brain.
- A ventriculoperitoneal shunt, also known as a VP shunt, is a small tube that is surgically inserted in a space in the brain. Excess CSF is drained from the brain into the abdomen through the thin tube. This can relieve symptoms of high pressure in the brain.
Some treatment options may only be available through clinical trials.