Clinical observation of intrathecal chemotherapy combined with concurrent radiotherapy for leptomeningeal metastases from malignant solid tumors

Abstract

Objective To investigate the efficacy and safety of intrathecal chemotherapy combined with concurrent radiotherapy in patients with leptomeningeal metastases from solid tumors. Methods The clinical and follow-up data of 29 patients with leptomeningeal metastases from malignant solid tumor who had intrathecal chemotherapy combined with concurrent radiotherapy were retrospectively analyzed.The treatment regimen was that 12.5-15.0 mg of methotrexate intrathecal injection once a week for 8 successive weeks combined with whole brain irradiation to a total dose of 40 Gy，20 fractions or with lumbosacral spinal canal irradiation to a total dose of 50 Gy，20-25 fractions. Results Nineteen patients completed the concurrent therapy and 19 patients were dead.There were 9 patients with complete remission of symptoms，11 with obvious improved symptoms，6 with alleviated symptoms，and 3 with no relief.All of the 29 patients，were followed up for 0.4-15.0 months.The median survival was 5 months.The 6-month survival rate was 48% (11/ 23)，excluding 4 patients with follow-up time less than 6 months and 2 patients noncancer deaths.The main toxicities were myelosuppression, methotrexate-related mucositis，chemical nerve root injuries，chemical meningitis，chronic neurotoxicity，seizures，and radiation-related mucositis. The incidence of severe toxicity was 17% (5/29). Conclusions Combination of intrathecal methotrexate with concurrent radiotherapy can effectively alleviate the symptoms and improve the life quality of patients.The therapy with low incidence of severe toxicity and good tolerance has the trendency to prolong the median survival. Key words: Neoplasm metastasis; Meningeal neoplasms; Radiotherapy; Drug therapy; Injections，spinal