Intrathecal chemotherapy for patients with meningeal carcinomatosis

Abstract Background Meningeal carcinomatosis (MC) is increasing, and these patients have a poor prognosis. We analyzed the effects of intrathecal (IT) chemotherapy for these patients. Methods Patients received both methotrexate (MTX) (15 mg/m 2 ) and prednisolone (10 mg/m 2 ) 6 times in 2 weeks by Ommaya reservoir, along with cytosine arabinoside (10 mg/m 2 ) for 4 doses of MTX. A cycle consisted of a 2-week period during which patients received these drugs and then 2 weeks off. Treatments were repeated 3 to 6 cycles depending on the clinical status. Cerebrospinal fluid (CSF) samples were also analyzed for cytology and a few markers. Results Of the 58 patients treated the most common tumor was lymphoma (30 patients), followed by lung and breast. Elevated soluble IL-2 receptor levels were observed in 23 of 30 patients with lymphomatous meningitis. Median survival of MC patients with malignant lymphoma, lung cancer, and breast cancer was 32.8 ± 9.8, 13.0 ± 4.1, and 18.4 ± 7.4 months, respectively. Thus, the patients with lymphoma responded best, both by clearing the CSF and clinically. Conclusions Our treatment regimen can improve the neurologic status of patients with MC. In particular, early IT chemotherapy can be effective for patients with lymphoma.