Continuous intrathecal chemotherapy with 5-fluoro-2'-deoxyuridine (FdUrd) in treatment of leptomeningeal carcinomatosis

Abstract

1566 Background: Previously, we reported a good clinical treatment effect of intrathecal chemotherapy (ITC) by repeated bolus administration of 5-fluoro-2'-deoxyuridine (FdUrd) for leptomeningeal carcinomatosis (LMC). Moreover, there was no side effects and neurotoxicity detected despite the long-term repetition of intrathecal administration (IT). From these findings, continuous ITC with FdUrd for patients (pts) with LMC was attemted using a simple pump system. We evaluate the usefulness of continuous IT of FdUrd in treatment of LMC. Method: A total of 25 pts were enrolled in this study between January 2000 and April 2003. FdUrd 1.0 mg/day was administered using a balloon pump system. Continuous ITC was continued as long as possible changing the balloon pump containing FdUrd solution once every 7 days. Eight patients received whole brain irradiation (WBI, 3 Gy X 10 times) simultaneously with IT of FdUrd. The effects of the treatment were analyzed in terms of improvement in neurological signs and symptoms, the findings of ventricular and lumbar cerebrospinal fluid (CSF) after 2 and 4 weeks and MR images 2 months after continuous IT of FdUrd was initiated. Survival time was calculated as of August, 31, 2003. Results: No apparent toxicity has been observed to date. Evidence of CSF response was observed in 15 pts. Headache and nausea was improved in all pts and cranial nerve impairment was improved in 12 pts. MR image response was observed in only 2 patients. Overall response was observed in 15 pts when cases of stable disease were excluded from the responding cases. Survival times (mean ±sem days, n) were 251±30, 25. The survival times in pts with and without WBI were 182±37, 8 and 285±39, 17, respectively (p=0.057). Conclusion: This therapy may be useful, especially as a maintenance therapy of LMC, although WBI seems to cause adverse effects. No significant financial relationships to disclose.