Carcinomatous Meningitis-Reply

In reply  We appreciate Chamberlain's thoughtful comments regarding our study of leptomeningeal carcinomatosis (LC). As noted in the "Comment" section of our review, we agree that patient selection bias remains a limitation of this retrospective study. Given the gravity of the condition as perceived by the patient, responsible family members, and the treating neurologists, some variation in clinical approach is likely present. We join Chamberlain in calling for a randomized prospective study of treatment modalities in LC to determine their efficacy.The route of intra-CSF chemotherapy (intraventricular vs intraspinal) was not analyzed as an independent variable of survival. Of course, the same inconsistencies in patient selection that limit the published conclusions would also apply to survival analysis based on a comparison of intra-CSF routes. Furthermore, patients typically received intraspinal chemotherapy until an Ommaya reservoir could be placed. Some patients died before an intraventricular administration device could be implanted, while others