RESUMO
Neoplastic meningitis occurs in approximately 5%-10% of all patients with cancer, and aggressive supportive measures are a critical component of comprehensive care. A literature review of the current diagnostic methods, randomized controlled trials, and available treatments was undertaken; and a comprehensive discussion of best-practice supportive care measures is provided. Although the prognosis for those diagnosed with neoplastic meningitis is poor, treatment and supportive care may allow stabilization of neurologic symptoms and afford protection from further neurologic deterioration, allowing patients to maximize their function and independence and adjust their expectations of treatment from cure to palliation.
Assuntos
Neoplasias Meníngeas/secundário , Neoplasias Meníngeas/terapia , Fatores Etários , Líquido Cefalorraquidiano/citologia , Quimiorradioterapia Adjuvante , Comorbidade , Continuidade da Assistência ao Paciente/organização & administração , Educação em Saúde , Humanos , Incidência , Carcinomatose Meníngea/secundário , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/epidemiologia , Saúde Mental , Manejo da Dor/métodos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Trombose Venosa/prevenção & controleRESUMO
High dose methotrexate has become one of the treatments of choice for patients with primary CNS lymphomas due to its ability to penetrate the blood-brain barrier. A potentially serious complication of this therapy is methotrexate-related nephrotoxicity. We report the case of a patient with a common genetic polymorphism that may have predisposed this patient experience clinically significant toxicity from systemic folate depletion. After the first cycle of chemotherapy that included high dose methotrexate, the patient's serum creatinine rose and the patient's methotrexate level remained above the toxic range for six days. On cycle two, the patient was treated with a 25% dose reduction in methotrexate and more aggressive hydration and alkalization. With this alteration in the regimen, the patient was able to receive six more cycles and had a complete radiographic tumor response in the brain and a disappearance of tumor cells in the CSF without any further renal complications. This case report illustrates the feasibility of administering high dose methotrexate with modifications as a treatment of choice in individuals with methylenetetrahydrofolate reductase gene mutations.