A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis.

Abstract

Forty-four patients with documented meningeal carcinomatosis (small-cell lung carcinoma [SCLC], 29%; breast carcinoma, 25%) were treated in a prospective randomized trial with intrathecal methotrexate (MTX) 15 mg or MTX plus cytosine arabinoside (Ara-C) 50 mg/m2. Most patients received intrathecal hydrocortisone (HC) each treatment to minimize arachnoiditis. Overall response was 55%. Seven patients achieved complete response. Response to MTX was superior to combined MTX/Ara-C, but not significantly so (61% v 45%; P greater than .10). Response was more frequent if drugs were administered via Ommaya reservoir than by lumbar puncture (65% v 48%; P greater than .10). Concurrent radiotherapy to the CNS was associated with significantly better response (73% v 35%; P less than .05). Small-cell lung carcinoma patients showed the best response (69%). Overall median survival for the whole group was 8 weeks, but responders fared better than nonresponders (median survival, 18 v 7 weeks; P less than .05). Nausea and vomiting were the most common toxicities encountered (45%), but rarely proved limiting. An unusual, previously undocumented reaction to intrathecal HC was noted. MTX is moderately effective in nonleukemic meningeal carcinomatosis, but the addition of Ara-C does not appear to improve results. Pretreatment factors did not predict outcome in this trial.

• Authors: R N Hitchins, D R Bell, R L Woods, J A Levi
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 5 Issue 10 Pg. 1655-62 (Oct 1987) ISSN: 0732-183X [Print] United States
• PMID: 3309199 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Drug Implants
• Cytarabine
• Methotrexate

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Clinical Trials as Topic
• Combined Modality Therapy
• Cytarabine (administration & dosage)
• Drug Implants
• Female
• Humans
• Male
• Meningeal Neoplasms (drug therapy, mortality, secondary)
• Methotrexate (administration & dosage, adverse effects, therapeutic use)
• Middle Aged
• Prospective Studies
• Random Allocation