Leptomeningeal metastases (LM) is the metastatic infiltration of leptomeninges by malignant cells originating from an extrameningeal primary tumor site that may be extraneural (most common) or intraneural (less common). Presence of carcinomatous meningitis is usually associated with poor survival. The survival is usually only weeks without treatment, but with treatment we may extend it to a few months. Our institute protocol is to offer intrathecal (IT) chemotherapy to patients with cerebrospinal fluid cytology-positive carcinomatous meningitis. So we intend to assess the clinical benefit to IT chemotherapy.
A retrospective review of electronic data at AIMS, Kochi, India. Patients with CSF cytology-positive solid tumours treated with triple IT chemotherapy were assessed. The regimen used was methotrexate 12 mg with cytosine arabinoside 70 mg dose 1 followed by 50 mg subsequently and hydrocortisone 50mg. Treatment sessions were repeated twice a week and patients were assessed for response by complete clearing of all malignant cells from lumbar CSF. The responders, whose CSF showed no malignant cells or no atypical cells, received a weekly maintenance therapy for at least four weeks with the same regimen as the previous one while response persisted.
A total of 20 patients with LM were analysed. The median age of the study group was 49 ± 9.86 years with a female preponderance in 55%. Eight had breast cancer, 7 lung, 3 stomach and 1 each with prostate and GBM. Seventy percent of the patients reported an improvement in symptoms after four doses. All patients had positive CSF cytology with the mean CSF glucose of 60 mg/dl, mean protein of 92 mg/dl and the mean cell count was 5. The median overall survival (OS) at 6 and 12 months were 38% and 14%, respectively. The median progression-free survival (PFS) was 2 months. On univariate analysis, patients with brain parenchymal involvement had poor 6 month OS (25% vs 50%, p = 0013) and 6 month PFS (0% vs 20%, p = 0.023).
Triple IT (methotrexate, cytoside arabinoside and hydrocortisone) for patients with leptomeningeal carcinomatosis showed good symptomatic control with a slightly improved survival and can be considered in patients with no parenchymal improvement as its involvement is associated with dismal outcomes.
Clinical trial identification
This is not a clinical trial
Legal entity responsible for the study
Amrita Institute of Medical Sciences, Kochi, India.
Has not received any funding.
All authors have declared no conflicts of interest.