The article by Balm and Hammack1 in a recent issue of the Archives is a commendable effort and reviews the recent study at the Mayo Clinic, Rochester, Minn. However, the study suffers from being a retrospective analysis and from the lack of a consistent approach to patients with leptomeningeal metastasis (LM).
For example, it is not clear why some patients were treated aggressively (n=52), vs offered no treatment (n=35) or radiation therapy only (n=37). Because their article suggests that aggressive treatment with intracerebrospinal fluid (intra-CSF) chemotherapy plus involved-field central nervous system radiation is associated with a better outcome, I believe it is incumbent on neurooncologists to conduct a randomized prospective study regarding the benefits of aggressive treatment. Several recent studies of the treatment of LM have suggested that administration of systemic chemotherapy plus involved-field central nervous system radiotherapy may be sufficient treatment.2
Furthermore, in the study by Balm
Chamberlain MC. Carcinomatous Meningitis. Arch Neurol. 1997;54(1):16–17. doi:10.1001/archneur.1997.00550130008003
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