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To the Editor:
Boogerd et al. describe two patients with breast cancer, neurologic signs and symptoms consistent with leptomeningeal metastases (LM), and CSF cytology positive for tumor cells who were treated with oral tamoxifen.1 Both patients had durable clinical responses notwithstanding the decision to forgo intra-CSF chemotherapy [I-CSF]. Several issues relevant to the treatment of LM were discussed and warrant comment.
First, the evaluation of patients with LM in whom treatment is pursued usually entails imaging of the entire neuraxis because LM often coexists with bulky metastatic disease. Bulky subarachnoid or parenchymal disease and clinically symptomatic sites of disease are best managed with radiotherapy.
Second, outcome of patients treated with LM is clearly dependent upon a number of patient characteristics, including tumor histology.
Third, the best treatment for LM remains ill-defined. However, based on four Phase 3 randomized clinical trials of LM, standard therapy utilizes both radiotherapy and I-CSF.2–5⇓⇓⇓ Pending a randomized clinical trial …
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