A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis.

Abstract

Forty-four patients with documented meningeal carcinomatosis (small-cell lung carcinoma [SCLC], 29%; breast carcinoma, 25%) were treated in a prospective randomized trial with intrathecal methotrexate (MTX) 15 mg or MTX plus cytosine arabinoside (Ara-C) 50 mg/m2. Most patients received intrathecal hydrocortisone (HC) each treatment to minimize arachnoiditis. Overall response was 55%. Seven patients achieved complete response. Response to MTX was superior to combined MTX/Ara-C, but not significantly so (61% v 45%; P greater than .10). Response was more frequent if drugs were administered via Ommaya reservoir than by lumbar puncture (65% v 48%; P greater than .10). Concurrent radiotherapy to the CNS was associated with significantly better response (73% v 35%; P less than .05). Small-cell lung carcinoma patients showed the best response (69%). Overall median survival for the whole group was 8 weeks, but responders fared better than nonresponders (median survival, 18 v 7 weeks; P less than .05). Nausea and vomiting were the most common toxicities encountered (45%), but rarely proved limiting. An unusual, previously undocumented reaction to intrathecal HC was noted. MTX is moderately effective in nonleukemic meningeal carcinomatosis, but the addition of Ara-C does not appear to improve results. Pretreatment factors did not predict outcome in this trial.

Concurrent radiotherapy and intrathecal methotrexate for treating leptomeningeal metastasis from solid tumors with adverse prognostic factors: A prospective and single‐arm study

“…LM patients with poor conditions may achieve clinical improvement after IC, however, the neurologic symptoms commonly relapse within a short time 24, 26. Such situation was also proved by our clinical experiences.…”

“…To our knowledge, lots of previous studies enrolled patients with various solid tumors2, 17, 24, 29, 30, 31, 32 despite the prognosis of LM from breast cancer was satisfactory 33. Therefore, patients with different primaries were enrolled in this study.…”

Neoplastic Meningitis

“…However, it is noted that most series exclude patients that are too sick to receive any treatment, which may be up to one third of patients with NM [64]. Three agents are routinely used: methotrexate, cytarabine (including liposomal cytarabine or DepoCyt [Enzon Phar- [65][66][67]. Table 1 outlines the randomized clinical trials conducted for NM whereas Table 2 is an outline of the common treatment regimens for intra-CSF chemotherapy.…”

Isolated Leptomeningeal Carcinomatosis in a Patient with Newly Diagnosed Gastric Cancer

“…Standard therapy involves IT chemotherapy in combination with radiotherapy (RT) (10). However, efficacy of IT chemotherapy is controversial because of uncertain survival benefit (10,11). Methotrexate remains the most frequently used drug for IT administration, despite limited success and serious toxicity (12).…”