Leptomeningeal Metastases: Novel Therapies, Future Directions and the Patient's Perspective

This panel session is the first ASTRO session dedicated to leptomeningeal disease in cancer. This is a case-based session with experts in neuroimaging, neuro-oncology, medical oncology, radiation oncology, as well as a patient speaker with LM disease who share their perspective. This comes on the heels of the landmark phase II randomized trial which showed improved central nervous system progression-free survival and overall survival with proton craniospinal irradiation (CSI) when compared to standard photon involved-field radiotherapy. We discuss several important aspects in the management of LM in this session. Using cases, we discuss the diagnosis and definition of LM disease as well as critical neuroimaging pearls (e.g., discerning LM disease from pachymeningeal disease). We go over cerebrospinal fluid (CSF) testing and intracranial pressure management. Furthermore, we discuss directed intrathecal therapies and systemic therapies for LM. We also discuss the most appropriate radiotherapeutic management based on patient selection, including photon involved-field radiotherapy, and proton and photon CSI. For all aspects, we deliver best practices, the latest scientific advances and how they could be incorporated into patient care. Most importantly, we also incorporate patient discussion and perspective in the treatment of LM.

Topics:

  1. Introductions and Definition of LM, Neuro-Imaging Pearls: Case-Based Review
    Jona A. Hattangadi-Gluth, MD
  2. Diagnostic and Therapeutic CSF Management: Intracranial Pressure Management Options, Intrathecal Therapy
    Rachna Malani, MD 
  3. Systemic Therapy for Leptomeningeal Metastases
    Allison Betof-Warner, MD, PhD
  4. Craniospinal irradiation for solid tumor leptomeningeal metastasis - How do we incorporate it in our management? 
    Jonathan T. Yang, MD, PhD
  5. Patient Perspectives on LM Disease/Panel Discussion and Q & A
    Anne Forth Laporte, BSN
    Full Panel 

This activity is available from March 5, 2024, through 11:59 p.m. Eastern time on March 4, 2026. 

This activity was originally recorded at the 2023 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, physicists, nurses, diagnostic radiologists, residents, neuro-oncology specialists.  

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Determine the current practice for patients with LM and the value of multidisciplinary management and opportunities for improvement.
  • Implement the diagnostic workup procedures for LM, including assessing for intracranial pressure and the appropriate management for it. 
  • Discuss treatment options with patients based on patient need and goals of care, including the most appropriate radiotherapeutic options and possible systemic and intrathecal treatment options as well as best supportive care. 
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Certificate of Attendance
    This activity was designated for 1.00 AMA PRA Category 1 Credit™.
Course opens: 
03/05/2024
Course expires: 
03/04/2026
Cost:
$0.00
Rating: 
0
  • Jona A. Hattangadi-Gluth, MD, is employed by the University of California San Diego, Morris Cancer Center. 
  • Rachna Malani, MD, is employed by the University of Utah, Huntsman Cancer Institute. Dr. Malani serves on the medical advisory board of Insightec. 
  • Allison Betof-Warner, MD, PhD, is employed by Stanford University School of Medicine. Dr. Betof-Warner receives consulting fees from BluePath Solutions, Bristol Myers Squibb, Immatics, Instil Bio, Iovance Biotherapeutics, Lyell Immunopharma, Novartis, and Pfizer. She receives institutional research funding from Iovance Biotherapeutics. She discusses off-label/investigational use of Nivolumab.
  • Jonathan T. Yang, MD, PhD, is employed by University of Washington - Fred Hutchinson Cancer Center. Dr. Yang receives consulting fees from Galera Therapeutics, Nanocan Therapeutics, and AstraZeneca. He receives research funding from AstraZeneca, Kazia Therapeutics, X-Rad Therapeutics, Debiopharm, and Biocept. 
  • Anne Forth Laporte, BSN, is employed by Patient Caregiver.  

  

The person(s) above served as the developer(s) of this activity. Additionally, the Education Committee had control over the content of this activity. All relevant relationships have been mitigated.

Disclosure link: 
Committee Disclosures

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing education to physicians.

ASTRO is awarded Deemed Status by the American Board of Radiology to provide SA-CME as part of Part II Maintenance of Certification. 

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Certificate of Attendance
    This activity was designated for 1.00 AMA PRA Category 1 Credit™.

Price

Cost:
$0.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

Nonmember: $149
Member: $99
Member-in-training: $49
Student/Grad Student/PGY: $49
Postdoctoral Fellow: $49
 

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the course by the end of the qualification date. The qualification date for each course is listed in the course catalog on the ASTRO website under availability.

Participants using ASTRO's online courses to satisfy the requirement of a Maintenance of Certification (MOC) program should verify the number, type and availability dates of any course before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased courses that do not align with their MOC requirement.

The course and its materials will only be available on the ASTRO website until March 4, 2026, regardless of purchase date. At the expiration of the qualification, participants will no longer have access to the course or its materials. ASTRO reserves the right to remove a course before the end of its qualification period.

Required Hardware/software

One of the two latest versions of Google Chrome, Mozilla Firefox, Internet Explorer or Safari.