VENTRICULOLUMBAR PERFUSION CHEMOTHERAPY WITH METHOTREXATE AND CYTOSINE-ARABINOSIDE FOR MENINGEAL CARCINOMATOSIS - A PILOT-STUDY IN 13 PATIENTS

Thirteen patients with meningeal carcinomatosis were treated by ventri culolumbar perfusion using methotrexate (MTX) and cytosine arabinoside (Ara-C). MTX (10-30 mg) and Ara-C (40 mg) were infused at 8- to 12-ho ur intervals on six or nine occasions via an Ommaya reservoir placed i n the lateral ventricle. Nine of thirteen patients had evaluable respo nse (69% response rate with a mean survival of 8.8 months among respon ders) and ventriculolumbar perfusion therapy was effective in improvin g cerebral, cranial nerve, and spinal root signs and symptoms, especia lly sensorimotor disturbance in the lower limbs. Three of the six bedr idden patients became ambulatory without assistance and two of the fou r patients who were walking with assistance became ambulatory without assistance. Urinary incontinence also markedly improved, except in one nonresponder. Lumbar cerebrospinal fluid parameters (cytological find ings and tumor markers) also improved in association with the clinical improvement. Our pilot results were encouraging, especially the impro vement of sensorimotor function in the lower limbs. However, the toxic ity was unacceptable when compared with that of standard intrathecal c hemotherapy, Thus, this therapy needs to be investigated further to es tablish the most appropriate drug doses and perfusate volume to reduce toxicity as well as determine its true efficacy in the treatment of m eningeal carcinomatosis.