Leptomeningeal Metastases of the Spine: A Systematic Review

Anticancer Res. 2022 Feb;42(2):619-628. doi: 10.21873/anticanres.15519.


Background/aim: Leptomeningeal metastases (LMs) of the spine have complex management. We reviewed the literature on spine LMs.

Materials and methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of spine LMs.

Results: We included 46 studies comprising 72 patients. The most frequent primary tumors were lung (19.4%) and breast cancers (19.4%). Median time from primary tumors was 12 months (range=0-252 months). Cauda equina syndrome occurred in 34 patients (48.6%). Nodular spine LMs (63.6%) were more frequent. Concurrent intracranial LMs were present in 27 cases (50.9%). Cerebrospinal fluid cytology was positive in 31 cases (63.6%). Cases were managed using palliative steroids (73.6%) with locoregional radiotherapy (55.6%) chemotherapy (47.2%), or decompressive laminectomy (8.3%). Post-treatment symptom improvement (32%) and favorable radiological response (28.3%) were not different based on treatment (p=0.966; p=0.727). Median overall-survival was 3 months (range=0.3-60 months), not significantly different between radiotherapy and chemotherapy (p=0.217).

Conclusion: Spine LMs have poor prognoses. Radiotherapy, chemotherapy, and surgery are only palliative, as described for intracranial LMs.

Keywords: Leptomeningeal metastases; radiotherapy; spine metastases; spine surgery; spine tumors; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Meningeal Neoplasms / mortality
  • Meningeal Neoplasms / secondary*
  • Meningeal Neoplasms / therapy
  • Middle Aged
  • Palliative Care
  • Prognosis
  • Spinal Cord Neoplasms / mortality
  • Spinal Cord Neoplasms / secondary*
  • Spinal Cord Neoplasms / therapy
  • Survival Rate