is used mostly for focal type of nm due to the nature of damage and success rate associated with the treatment. radiotherapy targets the tumor and destroys the collective tissues of cancerous cells. chemotherapy chemotherapy is injected directly into the cerebrospinal fluid, either by lumbar puncture (“spinal tap”) or through a surgically implanted device called an ommaya reservoir. intrathecal therapy is preferred since intravenous chemotherapy do not penetrate the bbb. the most common chemicals used are liposomal cytarabine (depocyte) and intrathecal methotrexate (mtx). the downside of a spinal tap diagnosis is that while it is highly accurate and reliable, it can also report false-negative results. chemotherapy is delivered intrathecally as it is hard for drugs to make it into the central nervous system. intrathecal chemotherapy can only penetrate a few millimeters. if the tumor is any thicker, radiation is given to shrink it down. the treatment is done to reduce pressure on the brain caused by any cerebrospinal fluid buildup and to reduce the number of cancer cells causing the pressure. for the best care, patients should see a physician who regularly treats leptomeningeal cancer and is most up-to-date on medicines that penetrate the blood-brain barrier, how to treat the symptoms, and clinical trials that might include patients with leptomeningeal cancer. risks of treatments both chemotherapy and radiotherapy are harmful to the body and most definitely the brain. caution must be utilized in treating patients with nm. another factor that makes treatment difficult is that there is no suitable method to evaluate the disease progression. prognosis the prognosis is generally poor with survival typically measured in months. the median survival time of patients without treatment is four to six weeks. the best prognoses are seen from nm due to breast cancer with the median overall survival of no more than six months after diagnosis of nm. death is generally due to progressive neurological dysfunction. treatment is meant to stabilize neurological function and prolong survival. neurological dysfunction usually cannot be fixed but progressive dysfunction can be halted and survival may be increased to four to six months. it occurs in approximately 3-5% of cancer patients. the disease is usually terminal and if left untreated, the median survival is 4–6 weeks whereas if treated, the median survival can increase to 2–3 months. treatment will be more effective if it is done on the primary tumor before it metastasizes to the brain or spinal cord. patients with leukaemia achieve better results compared to patients with solid tumours who have undergone treatment. it was found that 75% of patients stabilize or improve over several months as opposed to 25% of patients who do not respond and have progressive disease. but despite initial improvement, most patients survive only a few months. breast cancer and small cell lung cancer are the two solid tumors that respond best to treatment some patients do better than others, particularly those whose primary cancer is hematologic, bone marrow and lymph nodes. factors that lower survival much of prognosis can be determined from the damage due to primary cancer. negative hormone receptor status, poor performance status, more than 3 chemotherapy regimes, and high cyfra 21-1 level at diagnosis, all indicates lower survival period of patients with nm. cyfra 21-1 is a fragment of the cytokeratin 19 and may reflect the tumor burden within the csf. epidemiology in the united states, 1–8% of cancer patients are diagnosed with leptomeningeal disease, with approximately 110,000 cases per year. the exact incidence of leptomeningeal disease is difficult to determine, since gross examination at autopsy may overlook signs of leptomeningeal disease, and microscopic pathological inspection may be normal if the seeding is multifocal or if an unaffected area of the central nervous system (cns) is examined. current research new treatments and clinical trial for breast cancer patients and non-small cell lung cancer patients with leptomeningeal disease are currently being explored. people with leptomeningeal metastasis are generally excluded from clinical trials, thereby limiting the systematic assessment of novel therapies in this subgroup of patients with poor prognosis. more patients with leptomeningeal metastasis should be enrolled into trials investigating novel agents with the potential to penetrate the blood–brain barrier. novel approaches are being studied as currently available therapies are toxic and provide limited benefits. history neoplastic meningitis (nm) was first reported in the 1870s. gallery meningeal carcinomatosis in a patient with breast cancer (contrast-enhanced axial t1-weighted mri)