Intrathecal therapy with 198Au-colloid for meningosis prophylaxis

Abstract

Telecobalt irradiation in combination with intrathecal (IT) methotrexate has been replaced by IT 198Au-colloid and methotrexate for meningosis prophylaxis in leukemia. Seventy-seven children received 56-200 MBq 198Au-colloid. The distribution was measured with a scintillation camera having a data processing facility. The radiopharmaceutical is adsorbed at the surface of the spaces with cerebrospinal fluid (CSF) 10-20 h after application. The normal retention of the administered radioactivity in the intracranial subarachnoid space (ISS) and in the spinal subarachnoid space (SSS) were 52 +/- 10% and 26 +/- 9%, respectively. An impairment of the normal distribution was observed after IT methotrexate and also postinjection CSF leakage. The calculated radiation absorbed doses in the cerebral and spinal meninges at a depth of 0.01 cm, i.e. the thickness of the pia, were 45 +/- 17 mGy and 189 +/- 91 mGy, respectively, for 1 MBq administered 198Au-colloid. The dosimetry shows that an effective radiation absorbed dose of 18 Gy can be delivered to the cerebral meninges by the application of 400 MBq 198Au-colloid.

Carcinomatous meningitis: Leptomeningeal metastases in solid tumors

“…Other types of RT consisting of intra-CSF administration of radioisotopes[8191194] or radiolabeled monoclonal antibodies have been utilized but are considered experimental. [10167200]…”

MEDULLOBLASTOMA IN CHILDREN 0–3 YEARS OLD: Forty Years' Experience in Slovenia

“…How much the late secondary tumor in our patient was related to such treatment is impossible to tell. Treatment with radioactive sources is controversial and has been in general discouraged [7], although used for treatment in leukemias with little or no toxicity [8]. Maybe it could be reconsidered in moderate doses for postoperative treatment in very young children with MB, stage M0 in a trial comparing intrathecal applications of chemotherapeutic agents.…”

Leptomeningeal Metastasis

“…There are three main approaches to the use of intrathecal radioisotopes in the management of leptomeningeal metastasis 122 : 1) Direct intrathecal administration of a radioisotope [140][141][142] ; 2) Attaching a radioisotope to a targeted agent such as radiolabeled monoclonal antibodies (radioimmunotherapy) [143][144][145][146] ; and 3) Attaching a radioisotope to a microsphere that remains localized in the CSF space. 147 Although radiolabeled microsphere therapy is growing in popularity in the management of liver neoplasms, its role in leptomeningeal metastasis is in its infancy.…”