A comprehensive literature review on radiation treatment of leptomeningeal disease from solid tumor primaries reveals…there’s almost no high level data on the subject. Other than paying homage to the sole prospective trial in this arena, which demonstrated a CNS disease control and even survival benefit with proton craniospinal irradiation (CSI) for high-performing patients, the review largely relies on expert opinion. Figure 1 provides a nice algorithm for work up and tailoring aggressiveness of management based on performance and disease status, ranging from proton or conformal photon CSI to rapid palliative focal radiation to symptomatic gross disease or steroids alone. | Barbour, Adv Radiat Oncol 2023
