Intrathecal chemotherapy in carcinomatous meningitis from breast cancer

Laura Orlando, Giuseppe Curigliano, Marco Colleoni, Nicola Fazio, Franco Nole, Giovanni Martinelli, Saverio Cinieri, Rossella Graffeo, Giulia Peruzzotti, Aron Goldhirsch

Research output: Contribution to journalArticle

Abstract

Meningeal metastases occur in 2-3% of patients with breast cancer, leading to meurological morbidity and increased mortality. The criteria for treatment choice are controversial and intrathecal chemotherapy (ITC) has no documented role in the management of this disorder. We therefore evaluated the efficacy of an ITC regimen for patients presenting with carcinomatous meningitis from breast cancer. Patients and Methods: Patients with meningeal carcinomatosis with or without concomitant parenchymal brain metastasis, were treated with repeated courses of intrathecal chemotherapy according to the following alternated weekly schedule: Day 1: Thiotepa 10 mg, methotrexate 15 mg, hydrocortisone 30 mg; Day 5: cytarabine (Ara-C) 70 mg, methotrexate 15 mg, hydrocortisone 30 mg. Folinic acid 15 mg was given orally, every six hours after methotrexate on days 2-3 and 6-7. Results: Thirteen consecutive patients were treated. The median age was 45 (range 30-67) years. Eleven patients had performance status (PS) 2-3. Nine patients had other metastatic sites; synchronous parenchymal brain metastasis were present in 5 patients. Concomitant systemic chemotherapy was administered in 5 patients and external whole brain radiotherapy in 7 patients. With 12 evaluable patients we observed no responses or improvement in symptoms. Side-effects were minimal. Conclusion: In our series of patients, ITC failed to provide objective response or relief in clinical symptoms. Despite evidence reported in the literature indicating symptomatic improvement after ITC in a number of patients with leptomeningeal metastasis, the results of our study confirm the controversial role of ITC. New drugs and new modalities of treatment should be studied in order to efficiently control meningeal involvement of breast cancer.

Original languageEnglish
Pages (from-to)3057-3059
Number of pages3
JournalAnticancer Research
Volume22
Issue number5
Publication statusPublished - Sep 2002

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Keywords

  • Breast cancer
  • Intrathecal chemotherapy
  • Meningeal carcinomatosis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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