Need for a new treatment strategy: leptomeningeal carcinomatosis from gastric cancer.

Leptomeningeal carcinomatosis (LMC) is an extremely rare manifestation of gastric cancer. The treatment options are very limited for LMC; despite standard treatment with intrathecal chemotherapy, the prognosis is grim and the median overall survival is 3-4 months. Here we report on a patient with LMC from metastatic gastric cancer who was treated with a novel approach of high-dose systemic irinotecan, comparable with the dose utilized in treating primary brain tumors such as gliomas. Our patient not only had an excellent tumor response to this novel approach, but also had a prolonged overall survival of 13 months, which is unusual for LMC from gastric cancer.