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Cancer cells spreading in the fluid and membranes that bathe the brain and spinal cord, rather than as a solid lump. It causes headaches, nerve palsies and confusion and has been one of the hardest situations to treat.
Occurs in 5-10% of solid tumours (breast, lung, melanoma) and in leukaemia and lymphoma; diagnosed by MRI and cerebrospinal fluid cytology or ctDNA. Median survival has been weeks to months. Treatments are intrathecal chemotherapy or trastuzumab, craniospinal radiotherapy (proton craniospinal showed benefit at MSK), and increasingly CNS-penetrant drugs such as osimertinib at high dose, tucatinib and T-DXd. CNS prophylaxis in high-risk leukaemia and lymphoma exists to prevent it.
Shares Whole-brain radiotherapy (WBRT), HER2-positive breast cancer with brain metastases, Brain metastases (secondary brain tumours), Metastatic cancer (cancer that has spread).
Shares Intrathecal therapy (lumbar puncture, Ommaya reservoir), Whole-brain radiotherapy (WBRT), Brain metastases (intracranial disease).
Shares Whole-brain radiotherapy (WBRT), Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life, HER2-positive breast cancer with brain metastases, Brain metastases (secondary brain tumours).
Shares HER2-positive breast cancer with brain metastases, Brain metastases (secondary brain tumours), Brain metastases (intracranial disease).
Shares Whole-brain radiotherapy (WBRT), Brain metastases (secondary brain tumours).
Shares Whole-brain radiotherapy (WBRT), Brain metastases (secondary brain tumours), Metastatic cancer (cancer that has spread).
Shares Brain metastases (secondary brain tumours), Brain metastases (intracranial disease).
Shares CNS penetration (brain-penetrant drugs), Intrathecal therapy (lumbar puncture, Ommaya reservoir).