Japanese Journal of Clinical Oncology 33:608-612 (2003)
© 2003 Foundation for Promotion of Cancer Research
Comparison of Intrathecal Chemotherapy for Leptomeningeal Carcinomatosis of a Solid Tumor: Methotrexate Alone Versus Methotrexate in Combination with Cytosine Arabinoside and Hydrocortisone
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Objective: To compare the efficacy of intrathecal methotrexate single therapy with three-drug combination therapy in patients with leptomeningeal carcinomatosis.
Methods: Fifty-five patients who had pathologically proven leptomeningeal carcinomatosis of a solid tumor were evaluated in terms of pathological response. Group M (n = 29) received methotrexate 15 mg and group MHA (n = 26) received methotrexate 15 mg, hydrocortisone 15 mg/m2 and ara-C 30 mg/m2 twice a week intrathecally until a cytological response was obtained.
Results: Primary sites of the tumor were the lung (n = 33), breast (n = 13) and stomach (n = 5). The pathology of 45 patients was adenocarcinoma. The cytological response rate to intrathecal chemotherapy was significantly higher in the MHA group than in the M group (38.5 vs 13.8%, P = 0.036). The median survival was 18.6 weeks in the MHA arm and 10.4 weeks in the M arm (P = 0.029).
Conclusion: Combination intrathecal chemotherapy with methotrexate, cytosine arabinoside and hydrocortisone showed more favorable effects than methotrexate single therapy for leptomeningeal carcinomatosis in solid tumors.
+ For reprints and all correspondence: Dae Seog Heo, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongro-gu, Seoul, Korea. E-mail: heo1013{at}plaza.snu.ac.kr