Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group.

Grossman, Stuart A.; Finkelstein, Daniel; Ruckdeschel, John C.; Trump, Donald L.; Moynihan, T. T.; Ettinger, David S.

doi:10.1200/jco.1993.11.3.561

Cited by 338 publications

(227 citation statements)

References 17 publications

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“…Results from previous studies strongly suggest that breast cancer is the solid neoplasm that responds best to therapy. 2,5,12,26 However, our results suggest that, based on the selected clinical prognostic factors, the calculated prognostic index allowed the classification of patients into different prognostic groups regardless FIGURE 3. Overall survival curves for patients treated with intrathecal chemotherapy (A) and with palliative support (B) who were affected by leptomeningeal carcinomatosis according to an index of probability of survival that included the 3 independent prognostic variables Radiation Therapy Oncology Group score, glucose on cerebrospinal fluid, and infratentorial symptoms.…”

Section: Discussionmentioning

confidence: 85%

“…[1][2][3][4][5][6][7][8][9][10][11] Recently, an increased incidence of LC was observed because of the development of new, effective antineoplastic treatments against primary tumors and improvements in neuroimaging techniques. 7,12 Overall, current treatments offer a poor outcome and a high frequency of treatment-related toxicity. Without therapy, the median survival is 4 to 6 weeks, which can be extended to 4 months to 6 months with chemotherapy in selected patients.…”

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confidence: 99%

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Leptomeningeal carcinomatosis

Bruna

González²,

Miró³

et al. 2009

Cancer

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BACKGROUND:Leptomeningeal carcinomatosis (LC) represents a devastating complication of systemic cancer, and patients with LC have a dismal prognosis and increased mortality. The few studies that have focused on the evaluation of prognostic factors in patients with LC have resulted in contradictory results. Thus, the treatment of LC remains controversial, and no straightforward guidelines exist in the literature. The objective of the current study was to identify prognostic markers related to LC survival to better select patients who are eligible for intensive treatment.METHODS:Seventy patients who had a diagnosis of LC were reviewed, and clinical data, cerebrospinal fluid (CSF) parameters, tumor‐related characteristics, and treatment information were registered. The impact of single parameters on overall survival was determined by both univariate and multivariate analyses.RESULTS:The multivariate analysis revealed that Radiation Therapy Oncology Group score ≤2 (P = .028), a glucose level in CSF ≥2.7 mmol/L (P = .001), the presence of infratentorial symptoms at onset (P = .026), and intrathecal treatment (P < .001) were associated independently with longer overall survival in patients with LC. In addition, the same clinical factors also predicted response to treatment in such patients.CONCLUSIONS:The predictive factors for patients with LC that were identified in this study could help to better select patients who are more likely to benefit from chemotherapy. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionmentioning

confidence: 85%

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confidence: 99%

Leptomeningeal carcinomatosis

Bruna

González²,

Miró³

et al. 2009

Cancer

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Pan

Yang

et al. 2016

Intl Journal of Cancer

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The prognosis of leptomeningeal metastasis (LM) from solid tumors is extremely poor, especially for patients with adverse prognostic factors. In this phase II clinical trial, we evaluated the efficacy and safety of intrathecal chemotherapy (IC) combined with concomitant involved‐field radiotherapy (IF‐RT) for treating LM from solid tumors with adverse prognostic factors. Fifty‐nine patients with LM from various solid tumors were enrolled between May 2010 and December 2014. Concurrent therapy consisted of concomitant IC (methotrexate 12.5–15 mg and dexamethasone 5 mg, weekly) and IF‐RT (whole brain and/or spinal canal RT, 40 Gy/20f). For patients with low Karnofsky performance status (KPS) score and radiotherapy intolerance, induction IC (1–3 times) was given before concurrent therapy. Thirty‐eight patients (64.4%) received subsequent treatments. All patients were followed up at least 6 months after LM diagnosis or until death. Primary endpoint evaluated was clinical response rate. Secondary endpoints were overall survival (OS) and safety. The pathological types included lung cancer (n = 42), breast cancer (n = 11) and others (n = 6). Median KPS score was 40 (range 20–70). Fifty‐one patients (86.4%) completed concurrent therapy. The overall response rate was 86.4% (51/59). OS ranged from 0.4 to 36.7 months (median 6.5 months), and 1‐year‐survival rate was 21.3%. Treatment‐related adverse events mainly included acute meningitis, chronic‐delayed encephalopathy, radiculitis, myelosuppression and mucositis. Twelve patients (20.3%) had grade III–V toxic reactions. We concluded that IC combined with concomitant IF‐RT, with significant efficacy and acceptable toxicity, may be an optimal therapeutic option for treatment of LM from solid tumors with adverse prognostic factors. LM, in which cancer cells spread to membranes enveloping the brain and spinal cord, is a devastating complication of solid cancers. Existing LM therapies center on IC. In this prospective clinical study, the authors combined intrathecal methotrexate with involved‐field radiotherapy in a concomitant regimen, showing that the approach can potentially improve quality of life for patients with adverse prognostic factors. Concurrent radiotherapy‐bolstered IC by contributing to prolonged remission of neurological symptoms and increasing OS. The findings suggest that the concomitant regimen could be an optimal treatment option for LM.

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“…Progressive disease (PD) was defined as an increase of CSF tumor cells, while stable disease (SD) was considered to be any other condition. Response and SD were only documented if neurological symptoms had improved or remained stable; patients were otherwise assessed as having PD [2,4]. Response of measurable systemic disease was documented according to Cheson's criteria [14].…”

Section: Response and Toxicitymentioning

confidence: 99%

“…Standard therapy has not been established for these patients. Patients with leptomeningeal involvement usually receive intrathecal (IT) chemotherapy consisting of methotrexate (MTX) or cytarabine, which is sometimes combined with radiotherapy for nodular tumor masses [1][2][3][4]. Patients presenting with parenchymal brain involvement are usually submitted to whole-brain irradiation (WBI).…”

Section: Introductionmentioning

confidence: 99%

Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma

et al. 2008

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Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group.

Abstract: The efficacy and overall toxicities of intraventricular methotrexate and thiotepa seem similar and neither reverses fixed neurologic deficits. Early diagnosis and treatment and new therapeutic approaches are needed to improve the outcome for patients with neoplastic meningitis.

Cited by 338 publications

References 17 publications

Leptomeningeal carcinomatosis

Leptomeningeal carcinomatosis

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

Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma

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