LEPTOMENINGEAL METASTASES FROM SOLID TUMORS - A COMPARISON OF 2 PROSPECTIVE SERIES TREATED WITH AND WITHOUT INTRA-CEREBROSPINAL FLUID CHEMOTHERAPY

BACKGROUND. It has been suggested that an aggressive treatment of pati ents with leptomeningeal metastases (LM) that groups radiotherapy and intra-cerebrospinal fluid (intra-CSF) chemotherapy has improved treatm ent outcomes. Based on their previous series of 137 patients treated w ith such an intensive standard protocol, the authors expected 20% of t he patients to maintain their responses for at least 6 months after wi thdrawal of therapy. They also observed that, in patients with solid t umors, a partial response was compatable with sustained off-therapy re sponse and that the maximal response was reached soon after completion of radiotherapy. The authors concluded that the role of intra-CSF che motherapy, with its associated high rate of complications, is unclear. In this study, which was a further evaluation of this dilemma, they c ompared the outcomes of two prospective treatment protocols that were identical in their use of radiotherapy and systemic chemotherapy and v aried only in their inclusion or exclusion of intra-CSF chemotherapy. METHODS. Adult patients with LM from systemic solid tumors were prospe ctively included in the treatment protocol active at the time of their diagnosis. Group 1 comprised 54 patients treated by radiotherapy, int ra-CSF chemotherapy, and systemic therapy, whereas Group 2 comprised 5 0 patients treated with radiotherapy, and systemic chemotherapy but no intra-CSF chemotherapy. RESULTS. The analysis of treatment outcomes w as performed retrospectively. The median patient age and distribution of primary neoplasms did not differ between the two groups. The propor tion of early deaths that occurred during radiotherapy was similar for the two groups, as was the overall rate of response to treatment. The two groups also had the same median survival, which was 4 months for both groups, as well as the same proportion of long term survivors. Th irty-one percent of patients in Group 1 developed early complications related to intra-CSF chemotherapy, whereas patients in Group 2 were sp ared these complications. Delayed symptomatic leukoencephalopathy was observed in 20% of Group 1 patients compared with none in Group 2 (P = 0.02). CONCLUSIONS, The exclusion of intra-CSF chemotherapy from the treatment schedule of patients with LM does not change their overall r esponse to treatment, their median survival, or the proportion of long term survivors. It does, however, significantly reduce the rate of ea rly and delayed treatment-related complications. (C) 1998 American Can cer Society.