Retrospective survival analysis of intrathecal chemotherapy for meningeal carcinomatosis

AbstractBackground and Objectives: Leptomeningeal metastasis, also known as leptomeningeal carcinomatosis (LMC), a rare metastatic tumor in the central nervous system, has seen an increasing incidence in recent years. This rise is attributed to improved survival rates in patients with malignant tumors. However, the treatment of LMC remains a global challenge. Intrathecal chemotherapy, the primary treatment approach, lacks standardized guidelines. This study aims to assess the efficacy, safety, and prognosis of intrathecal methotrexate, cytarabine, and pemetrexed in treating LMC. Methods This retrospective analysis encompassed clinical data and cerebrospinal fluid (CSF) laboratory tests from 66 patients with LMC. The study also examined the adverse effects and prognosis following intracranial chemotherapy. Results Of the patients treated, 73.4% experienced clinical symptomatic relief, 73.5% showed normalization of intracranial pressure, and 52.8% had negative CSF cytology results. Moreover, 64.8% reported no discomfort, while 22.2% experienced mild adverse effects. Intrathecal chemotherapy significantly reduced CSF leukocytes and tumor cell counts, as well as protein levels, in patients with LMC. Notably, a median survival of 9.6 months was observed. Factors such as age, gender, and pre-treatment intracranial pressure did not influence survival in patients receiving intrathecal chemotherapy. However, patients receiving ≥ 10 times of intrathecal chemotherapy showed a significant prolongation of survival, with a P value < 0.05. Conclusion Intrathecal chemotherapy can improve clinical symptoms, decrease elevated intracranial pressure, and markedly reduce CSF tumor cells and meningeal damage in patients with LMC. Additionally, a comprehensive course of intrathecal chemotherapy can substantially improve survival rates, with a low incidence of serious adverse effects.