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Published in Brain Cancer

Expert Opinion / Cases · June 03, 2019

Management of Pachymeningeal Carcinomatosis

Written by
Jose McFaline-Figueroa MD, PhD


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  • amarnath gopalraj

    Jun 07, 2019

    I agree to the practice update community guidelines very very useful in my oncology practice

  • amarnath gopalraj

    Jun 07, 2019

    For diffuse dural mets I would suggest tomotherapy to hit the target
    Since dural mets from bladder ca is rare we do not have enough evidence at this point of time to suggest appropriate systemic therapy along with RT

  • John Leung

    Jun 09, 2019

    There is always the question, "will the agent penetrate the blood brain barrier (BBB)?"
    In the case of pembrolizumab, many would consider the monoclonal antibody too large to get through to the brain. But as a PD-1 inhibitor its site of action is on the immune cells where it protects them from the suppressive  apoptotic signal from tumour-emitted PD-L1. Once so primed, the host immune cells then actively migrate to the tumour site, independent of the BBB.
    Radiotherapy would enhance the efficacy of checkpoint inhibitors, but the patient must fully understand the side effects of WBRT which could be devastating. If the dural mets are not extensive, ciber knife RT may be considered.

  • Feb 23, 2024

    Pending Moderator approval.

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