Leptomeningeal Cancer

Symptoms of Leptomeningeal Disease

The symptoms of LMD can vary depending on which areas of the brain, spinal cord or cranial nerves are affected. Potential symptoms include:

Neurological Problems

• Headaches
• Seizures
• Cognitive or behavioral changes, including confusion and memory loss
• Nausea and vomiting (often due to increased intracranial pressure)

Motor and Sensory Issues

• Weakness or numbness in limbs, especially the legs
• Difficulty walking or balancing
• Sensory deficits, including changes in vision, hearing, taste, or smell

Cranial Nerve Symptoms

• Facial weakness or drooping
• Difficulty swallowing
• Double vision or other visual disturbances

Other Symptoms

• Back or neck pain
• Problems with urine and stool control

Leptomeningeal Disease Diagnosis

LMD can be challenging to diagnose because some of its symptoms can mimic other diseases. We use advanced diagnostic methods, including magnetic resonance imaging (MRI) of your brain or spine, and a lumbar puncture (spinal tap) to extract and examine cerebrospinal fluid for cancer cells.  

Leptomeningeal Disease Treatment

The treatment for LMD is typically aimed at managing symptoms, slowing disease progression, and improving quality of life. Our multidisciplinary team of oncologists, neuro-oncologists, radiation oncologists, neurosurgeons, and palliative care specialists works together to provide personalized treatment. This may include:

Intrathecal Chemotherapy

Chemo is delivered directly into the cerebrospinal fluid via a reservoir chemotherapy port (such as an Ommaya reservoir) that is inserted into the brain. This is a small plastic dome placed under your scalp.

Common chemo drugs include topotecan, pemetrexed, methotrexate, cytarabine or thiotepa. In addition, some targeted medications are used for specific types of cancers.

Systemic Therapy

This can include traditional chemotherapies, novel targeted therapies or immunotherapies based on the type of primary cancer (such as HER2-targeted drugs for breast cancer).

Radiation Therapy

Your treatment plan may include various types of radiation, including focused radiation, whole-brain radiation and cerebrospinal radiation.

UC San Diego Health radiation oncologists offer proton therapy at California Protons Cancer Therapy Center, one of the nation's largest and most advanced proton therapy centers.

Proton therapy is a precise and less invasive way to treat cancer. It uses tiny particles called protons to target tumors with radiation while minimizing damage to surrounding healthy tissues.

Because the radiation stops at the tumor, proton therapy can be especially helpful for people who are sensitive to radiation or have already had radiation in the same area.

Supportive Care

• Corticosteroids to reduce inflammation and swelling
• Anti-seizure medications
• Pain management

Prognosis for Patients with LMD

Leptomeningeal disease is a complication of late-stage cancer. Every patient with this condition is unique, and our team is dedicated to providing customized care to help extend and improve your quality of life.

Leptomeningeal Cancer Providers

Neuro-oncology

Jessica Schulte, MD, PhD
David Piccioni, MD, PhD
Heather Orosco PA-C

Medical Oncology

Rebecca Shatsky, MD (breast cancer)
Lyudmila Bazhenova, MD (lung cancer)

Neurosurgery

Jeffrey Steinberg, MD
Thomas Beaumont, MD, PhD

Radiation Therapy

Jona Hattangadi-Gluth, MD
Kathryn Tringale, MD

Neuro-oncology Radiology

Nikdokht (Niky) Farid, MD
Jennifer Chang, MD

Pathology/Genetics

Wei Song, MD, PhD