These EANO–ESMO joint recommendations for the diagnosis and treatment of leptomeningeal metastasis (LM) from solid cancers represent the first European guideline initiative on this topic. LM is defined as the spread of tumour cells within the leptomeninges and the subarachnoid space, is synonymous with ‘neoplastic meningitis’ and can be further denoted by primary tumour as leptomeningeal carcinomatosis, gliomatosis or lymphomatosis. The recommendations address LM from solid tumours, but neither LM from primary brain tumours nor LM from lymphoma or leukaemia. They cover prevention, diagnosis, therapy and follow-up, but not differential diagnosis, adverse effects of therapeutic measures or supportive or palliative care. We propose diagnostic criteria as well as a neuroimaging- and cytopathology-based classification of LM syndromes to derive pragmatic treatment algorithms. We also assign levels of certainty to the diagnosis of LM to provide guidance when to treat (as opposed to when to intensify diagnostic efforts) and on which patients to include in clinical trials. Given the low level of evidence, the recommendations are based more on expert opinion and consensus than on evidence from informative clinical trials. Still, the EANO–ESMO multidisciplinary recommendations shall serve as a valuable source of information for physicians, other health care providers, as well as informed patients and relatives.
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