
E. N. TEITELBAUM ET AL.
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LC such as meningeal enhancement [3,4]. While imaging
can serve as a useful guide, CSF histology remains the
gold standard for diagnosis of LC. CSF cytology is posi-
tive for malignant cells in 50% - 70% of cases, although
this yield can be increased to 90% with second and third
lumbar punctures. Increased opening pressures, high
protein and low glucose levels are also common findings
on CSF examination [5].
LC remains a bleak diagnosis with median survivals of
one to five months in treated patients and four to six
weeks if left untreated [2,6,7]. Wasserstrom reviewed 90
patients with LC from various primary tumors treated
with intrathecal methotrexate. The 23 patients with all
type lung cancer primaries had a 50% response rate and a
median survival of 4 months [6]. Chamberlain studied a
selective population of patients with LC from non-small
cell lung cancer primaries. These 32 patients were treated
with intrathecal methotrexate and some received in-
trathecal cytarabine and thiotepa as second and third-line
therapies respectively. Twelve of the patients received
concurrent systemic chemotherapy. Complete cytologica l
and partial clinical responses were seen in 43% of pa-
tients treated with methotrexate, 50% of those treated
with cytarabine and 33% of those treated with thiotepa.
Median survival was five months and no difference was
seen in the patients who also received systemic chemo-
therapy [2]. Other therapies used in LC have included
gemcitabine and ara-C, as well as radiotherapy and sur-
gery to palliate compressive brain or spinal cord metas-
tases [8].
4. Conclusions
LC is a rare complication of non-small cell lung cancer
that imparts a dismal prognosis. Diagnosis is made by
imaging and CSF evaluation with cytology. Treatment
with intrathecal chemotherapy results in a small im-
provement in life expectancy. As such, palliation of
symptoms and discussions with patients and their family
members regarding realistic expectations for prognosis
are important aspects of care.
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