Carcinomatous Meningitis

The article by Balm and Hammack¹in a recent issue of theArchivesis a commendable effort and reviews the recent study at the Mayo Clinic, Rochester, Minn. However, the study suffers from being a retrospective analysis and from the lack of a consistent approach to patients with leptomeningeal metastasis (LM). For example, it is not clear why some patients were treated aggressively (n=52), vs offered no treatment (n=35) or radiation therapy only (n=37). Because their article suggests that aggressive treatment with intracerebrospinal fluid (intra-CSF) chemotherapy plus involved-field central nervous system radiation is associated with a better outcome, I believe it is incumbent on neurooncologists to conduct a randomized prospective study regarding the benefits of aggressive treatment. Several recent studies of the treatment of LM have suggested that administration of systemic chemotherapy plus involved-field central nervous system radiotherapy may be sufficient treatment.² Furthermore, in the study by Balm