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Current Treatment of Leptomeningeal Metastases: Systemic Chemotherapy, Intrathecal Chemotherapy and Symptom Management

  • Chapter
Leptomeningeal Metastases

Part of the book series: Cancer Treatment and Research ((CTAR,volume 125))

Abstract

Treatment of leptomeningeal metastases is multifaceted and includes symptomatic therapy, intrathecal and systemic chemotherapy, and radiotherapy. As the majority of patients have widespread incurable systemic tumor, treatment is predominantly palliative; however, some patients with leukemia, lymphoma or breast cancer may have prolonged remissions and the possibility of cure.

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References

  1. Evans A, Gilbert E, Zandstra R. The increasing incidence of central nervous system leukemia in children. Cancer 1970; 26:404–407.

    PubMed  CAS  Google Scholar 

  2. Posner J, Chernik N. Intracranial metastases from systemic cancer. Advances in Neurology 1978; 19:579–592.

    PubMed  CAS  Google Scholar 

  3. Boyle R, Thomas M, Adams J. Diffuse involvement of the leptomeninges by tumour-a clincial and pathological study of 63 cases. Postgraduate Med J 1980; 56:149–158.

    CAS  Google Scholar 

  4. Whelan HT, Sung JH, Mastri AR. Diffuse leptomeningeal gliomatosis: Report of three cases. Clin Neuropathol 1987; 6:164–168.

    PubMed  CAS  Google Scholar 

  5. Civitello LA, Packer RJ, Rorke LB, et al. Leptomeningeal dissemination of low-grade gliomas in childhood. Neurology 1988; 38:562–566.

    PubMed  CAS  Google Scholar 

  6. Davila G, Duyckaerts C, Lazareth JP, et al. Diffuse primary leptomeningeal gliomatosis. J Neurooncol 1993; 15:45–49.

    Article  PubMed  CAS  Google Scholar 

  7. Bailey P, Robitaille Y. Primary diffuse leptomeningeal gliomatosis. Can J Neurol Sci 1985; 12:278–281.

    PubMed  CAS  Google Scholar 

  8. Ausman J, Shrontz C, Chason J, et al. Aggressive choroid plexus papilloma. Surg Neurol 1984; 22:472–476.

    Article  PubMed  CAS  Google Scholar 

  9. Deutsch M. The impact of myelography on the treatment results for medulloblastoma. Int J Rad Oncol Biol Phys 1984; 10:999–1003.

    CAS  Google Scholar 

  10. Jennings MT, Slatkin N, D'Angelo M, et al. Neoplastic meningitis as the presentation of occult primitive neuroectodermal tumors. J Child Neurol 1993; 8:306–312.

    Article  PubMed  CAS  Google Scholar 

  11. Ross G, Rubenstein L. Lack of histopathological correlation of malignant ependymomas with postoperative survival. J Neurosurg 1989; 70:31–36.

    PubMed  CAS  Google Scholar 

  12. Trigg M, Makuch R, Glaubiger D. Actuarial risk of isolated cns involvement in Ewing's sarcoma following prophylactic cranial irradiation and methotrexate. Int J Radiatr Oncol Biol Phys 1985; 11:699–702.

    Article  CAS  Google Scholar 

  13. Jenkin R, Simpson W, Keen C. Pineal and suprasellar germinomas: Results of treatment. J Neurosurg 1978; 48:99–107.

    PubMed  CAS  Google Scholar 

  14. Goldwein J, Corn B, Findlay J, et al. Is craniospinal irradiation required to cure children with malignant (anaplastic) intracranial ependymomas? Cancer 1991; 67:2766–2771.

    PubMed  CAS  Google Scholar 

  15. Olson M, Chernik N, Posner J. Infiltration of the leptomeninges by systemic cancer: A clinical and pathologic study. Arch Neurol 1974; 30:122–137.

    PubMed  CAS  Google Scholar 

  16. Wasserstrom W, Glass J, Posner J. Diagnosis and treatment of leptomeningeal metastases from solid tumors: Experience with 90 patients. Cancer 1982; 49:759–772.

    PubMed  CAS  Google Scholar 

  17. Little J, Dale A, Okazaki H. Meningeal carcinomatosis: Clinical manifestations. Arch Neurol 1974; 30:138–143.

    PubMed  CAS  Google Scholar 

  18. Theodore W, Gendelman S. Meningeal carcinomatosis. Arch Neurol 1981; 38:696–699.

    PubMed  CAS  Google Scholar 

  19. Kaplan JG, DeSouza TG, Farkash A, et al. Leptomeningeal metastases: Comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias. J Neurooncol 1990; 9:225–229.

    Article  PubMed  CAS  Google Scholar 

  20. Bigner S, Johnston W. The cytopathology of cerebrospinal fluid. Acta Cytologica 1981; 25:461–477.

    PubMed  CAS  Google Scholar 

  21. Kokkoris C. Leptomeningeal carcinomatosis: How does cancer reach the pia-arachnoid? Cancer 1983; 51:154–160.

    PubMed  CAS  Google Scholar 

  22. Gonzalez-Vitale J, Garcia-Bunuel R. Meningeal carcinomatosis. Cancer 1976; 37:2906–2911.

    PubMed  CAS  Google Scholar 

  23. DeAngelis LM. Current diagnosis and treatment of leptomeningeal metastasis. J Neurooncol 1998; 38:245–252.

    Article  PubMed  CAS  Google Scholar 

  24. Gelber R, Sallan S, Cohen H, et al. Central nervous system treatment in childhood acute lymphoblastic leukemia. Cancer 1993; 72:261–270.

    PubMed  CAS  Google Scholar 

  25. Ribeiro R, Rivera G, Hudson M, et al. An intensive re-treatment protocol for children with an isolated cns relapse of acute lymphoblastic leukemia. J Clin Oncol 1995; 13:333–358.

    PubMed  CAS  Google Scholar 

  26. Steinherz P. Cns leukemia: Problem of diagnosis, outcome, and treatment. J Clin Oncol 1995; 13:310–313.

    PubMed  CAS  Google Scholar 

  27. Chamberlain M, Kormanik P. Neoplastic meningitis: A guide to diagnosis and treatment. CNS Drugs 1998; 10:25–41.

    Article  Google Scholar 

  28. Glantz MJ, Jaeckle KA, Chamberlain MC, et al. A randomized controlled trial comparing intrathecal sustained-release cytarabine (depocyt) to intrathecal methotrexate in patients with neoplastic meningitis from solid tumors. Clin Cancer Res 1999; 5:3394–3402.

    PubMed  CAS  Google Scholar 

  29. Glantz M, Chamberlain M, Shapiro W, et al. A randomized trial of a slow-release formulation of cytarabine for the treatment of lymphomatous meningitis. J Clin Oncol 1999; 17:3110–3116.

    PubMed  CAS  Google Scholar 

  30. Hitchins R, Bell D, Woods R, et al. A prospective randomized trial of single-agent versus combination therapy in meningeal carcinomatosis. J Clin Oncol 1987; 5:1655–1662.

    PubMed  CAS  Google Scholar 

  31. Grossman SA, Finkelstein DM, Ruckdeschel JC, et al. Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. Eastern cooperative oncology group. J Clin Oncol 1993; 11:561–569.

    PubMed  CAS  Google Scholar 

  32. Jaeckle KA, Phuphanich S, Bent MJ, et al. Intrathecal treatment of neoplastic meningitis due to breast cancer with a slow-release formulation of cytarabine. Br J Cancer 2001; 84:157–163.

    Article  PubMed  CAS  Google Scholar 

  33. Balm M, Hammack J. Leptomeningeal carcinomatosis. Arch Neurol 1996; 53: 626–632.

    PubMed  CAS  Google Scholar 

  34. Grossman S, Moynihan T. Neurologic complications of systemic cancer: Neoplastic meningitis. Neurol Clin 1991; 9:843–856.

    PubMed  CAS  Google Scholar 

  35. Glass J, Melamed M, Chernik N, et al. Malignant cells in cerebrospinal fluid: The meaning of a positive CSF cytology. Neurology 1979; 29:1369–1375.

    PubMed  CAS  Google Scholar 

  36. Chamberlain M, Sandy A, Press G. Leptomeningeal metastasis: A comparison of gadolinium-enhanced MR and contrast-enhanced ct of the brain. Neurology 1990; 40:435–438.

    PubMed  CAS  Google Scholar 

  37. Chamberlain M. Comparative spine imaging in leptomeningeal metastases. J Neurooncol 1995; 23:233–238.

    Article  PubMed  CAS  Google Scholar 

  38. Glantz M, Hall W, Cole B, et al. Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow studies. Cancer 1995; 75:2919–2931.

    PubMed  CAS  Google Scholar 

  39. Chamberlain M, Kormanik P. Prognostic significance of 111indium-dtpa CSF flow studies. Neurology 1996; 46:1674–1677.

    PubMed  CAS  Google Scholar 

  40. Chamberlain M, Kormanik P. Prognostic significance of co-existent bulky metastatic CNS disease in patients with leptomeningeal metastases. Arch Neurol 1997; 54:1364–1368.

    PubMed  CAS  Google Scholar 

  41. Grossman S, Trump D, Chen D, et al. Cerebrospinal fluid flow abnormalities in patients with neoplastic meningitis. Am J Med 1982; 73:641–647.

    Article  PubMed  CAS  Google Scholar 

  42. Larson S, Schall G, DiChiro G. The influence of previous lumbar puncture and pneumoencephalography on the incidence of unsuccessful radioisotope cisternography. J Nuclear Med 1971; 12:555–557.

    CAS  Google Scholar 

  43. Giannone L, Greco F, Hainsworth J. Combination intraventricular therapy for meningeal neoplasia. J Clin Oncol 1986; 4:68–73.

    PubMed  CAS  Google Scholar 

  44. Chamberlain M. Alpha-interferon in the treatment of neoplastic meningitis. 2002. In Press

    Google Scholar 

  45. Glantz M, Chamberlain M, Walters B. Diagnosis and outcome measures for neoplastic meningitis: A review of the literature and clinical experience. Neurosurgery Focus 1998; 4:Article 4.

    Google Scholar 

  46. Balis F, Savitch J, Bleyer W, et al. Remission induction of meningeal leukemia with high-dose intravenous methotrexate. J Clin Oncol 1985; 3:485–489.

    PubMed  CAS  Google Scholar 

  47. Balis F, Holcenberg J, Blaney S. General prinicples of chemotherapy. In: Pizzo P, Poplack D, eds. Principles and practice of pediatric oncology. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2002:237–308.

    Google Scholar 

  48. Shapiro W, Young D, Mehta B. Methotrexate: Distribution in cerebrospinal fluid after intravenous, ventricular, and lumbar injections. New Engl J Med 1975; 293:161–166.

    Article  PubMed  CAS  Google Scholar 

  49. Frick J, Rich P, Hansen R, et al. Successful treatment of meningeal leukemia using systemic high-dose cytosine arabinoside. J Clin Oncol 1984; 2:365–368.

    PubMed  CAS  Google Scholar 

  50. Donehower R, Karp J, Burke P. Pharmacology and toxicity of high-dose cytarabine by 72-hour continuous infusion. Cancer Treat Rep 1986; 70:1059–1065.

    PubMed  CAS  Google Scholar 

  51. Nand S, Messmore H, Patel R, et al. Neurotoxicity associated with systemic high-dose cytosine arabinoside. J Clin Oncol 1986; 4:571–575.

    PubMed  CAS  Google Scholar 

  52. Heideman R, Cole D, Balis F, et al. Phase I and pharmacokinetic evaluation of thiotepa in the cerebrospinal fluid and plasma of pediatric patients: Evidence for dose-dependent plasma clearance of thiotepa. Cancer Res 1989; 49:736–741.

    PubMed  CAS  Google Scholar 

  53. Heideman R, Packer R, Reaman G, et al. A phase II evaluation of thiotepa in central nervous system malignancies. Cancer 1992; 72:271–275.

    Google Scholar 

  54. Slevin M, Piall E, Aherne G, et al. Effect of dose and schedule on pharmacokinetics of high-dose cytosine arabinoside in plasma and cerebrospinal fluid. J Clin Oncol 1983; 1:546–551.

    PubMed  CAS  Google Scholar 

  55. Lopez J, Nassif E, Vannicola P, et al. Central nervous system pharmacokinetics of high-dose cytosine arabinoside. J Neurooncol 1985; 3:119–124.

    Article  PubMed  CAS  Google Scholar 

  56. Ackland S, Schilsky R. High-dose methotrexate: A critical reappraisal. J Clin Oncol 1987; 5:2017–2031.

    PubMed  CAS  Google Scholar 

  57. Balis FM, Poplack DG. Central nervous system pharmacology of antileukemic drugs. Am J Pediatr Hematol Oncol 1989; 11:74–86.

    Article  PubMed  CAS  Google Scholar 

  58. Siegal T. Leptomeningeal metastases: Rationale for systemic chemotherapy or what is the role of intra-csf-chemotherapy? J Neurooncol 1998; 38:151–157.

    Article  PubMed  CAS  Google Scholar 

  59. Boogerd W, Hart AA, van, et al. Meningeal carcinomatosis in breast cancer. Prognostic factors and influence of treatment. Cancer 1991; 67:1685–1695.

    PubMed  CAS  Google Scholar 

  60. Fizazi K, Asselain B, Vincent-Salomon A, et al. Meningeal carcinomatosis in patients with breast carcinoma. Cancer 1996; 77:1315–1323.

    Article  PubMed  CAS  Google Scholar 

  61. Chamberlain M, Kormanik P, Glantz M. Recurrent primary central nervous system lymphoma complicated by lymphomatous meningitis. Oncol Rep 1998; 5:521–523.

    PubMed  CAS  Google Scholar 

  62. Pinedo H, Zaharko D, Bull J, et al. The reversal of methotrexate cytotoxicity to mouse bone marrow cells by leucovorin and nucleosides. Cancer Res 1976; 36:4418–4424.

    PubMed  CAS  Google Scholar 

  63. Widemann B, Hetherington M, Smithson W, et al. Carboxypeptidase-g2 as a rescue agent following methotrexate induced renal failure or intrathecal methotrexate overdose. Proc Am Assoc Cancer Res 1995; 36:1384.

    Google Scholar 

  64. Walker R, Allen J, Rosen G, et al. Transient cerebral dysfunction secondary to high-dose methotrexate. J Clin Oncol 1986; 4:1845–1950.

    PubMed  CAS  Google Scholar 

  65. Bleyer W. Neurologic sequelae of methotrexate and ionizing radiation: A new classification. Cancer Treat Rep 1981; 65:89–98.

    PubMed  Google Scholar 

  66. Slevin M, Piall E, Aherne G, et al. The pharmacokinetics of cytosine arabinoside in the plasma and cerebrospinal fluid during conventional and high-dose therapy. Med Pediatr Oncol 1982; 1:157–168.

    Google Scholar 

  67. Zimm S, Ettinger L, Holcenberg J, et al. Phase i and clinical pharmacological study of 6-mercaptopurine administered as a prolonged intravenous infusion. Cancer Res 1985; 45:1869–1873.

    PubMed  CAS  Google Scholar 

  68. Adamson P, Zimm S, Ragab A, et al. A phase ii trial of continuous-infusion 6-mercaptopurine for childhood solid tumors. Cancer Chemother Pharmacol 1990; 26:343–344.

    Article  PubMed  CAS  Google Scholar 

  69. Blaney S, Cole D, Balis F, et al. Plasma and cerebrospinal fluid pharmacokinetic study of topotecan in nonhuman primates. Cancer Res 1993; 53:725–727.

    PubMed  CAS  Google Scholar 

  70. Blaney SM, Phillips PC, Packer RJ, et al. Phase ii evaluation of topotecan for pediatric central nervous system tumors. Cancer 1996; 78:527–531.

    Article  PubMed  CAS  Google Scholar 

  71. Friedman HS, Kerby T, Fields S, et al. Topotecan treatment of adults with primary malignant glioma. The brain tumor center at duke. Cancer 1999; 85:1160–1165.

    Article  PubMed  CAS  Google Scholar 

  72. Macdonald D, Cairncross G, Stewart D, et al. Phase ii study of topotecan in patients with recurrent malignant glioma. National clinical institute of Canada Clinical Trials Group. Ann Oncol 1996; 7:205–207.

    PubMed  CAS  Google Scholar 

  73. Oberhoff C, Kieback DG, Wurstlein R, et al. Topotecan chemotherapy in patients with breast cancer and brain metastases: Results of a pilot study. Onkologie 2001; 24:256–260.

    Article  PubMed  CAS  Google Scholar 

  74. Blaney SM, Takimoto C, Murry DJ, et al. Plasma and cerebrospinal fluid pharmacokinetics of 9-aminocamptothecin (9-ac), irinotecan (cpt-11), and sn-38 in nonhuman primates. Cancer Chemother Pharmacol 1998; 41:464–468.

    Article  PubMed  CAS  Google Scholar 

  75. Friedman HS, Petros WP, Friedman AH, et al. Irinotecan therapy in adults with recurrent or progressive malignant glioma. J Clin Oncol 1999; 17:1516–1525.

    PubMed  CAS  Google Scholar 

  76. Chamberlain M. Salvage chemotherapy with cpt-11 for recurrent glioblastoma multiforme. Journal of Neuro-Oncology 2002 (In Press).

    Google Scholar 

  77. Chamberlain M. Salvage chemotherapy with cpt-11 for oligodendroglioma. J Neurooncol 2002 (In Press).

    Google Scholar 

  78. Balis F, Lester C, Chrousos G, et al. Differences in cerebrospinal fluid penetration of corticosteroids: Possible relationship to the prevention of meningeal leukemia. J Clin Oncol 1987; 5:202–207.

    PubMed  CAS  Google Scholar 

  79. Jones B, Freeman Al, Shuster JJ, et al. Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia. Med Pediatr Oncol 1991; 19:269–275.

    PubMed  CAS  Google Scholar 

  80. Hurwitz CA, Silverman LB, Schorin MA, et al. Substituting dexamethasone for prednisone complicates remission induction in children with acute lymphoblastic leukemia. Cancer 2000; 88:1964–1969.

    Article  PubMed  CAS  Google Scholar 

  81. Tallal L, Tan C, Oettgen H, et al. E. Coli 1-asparaginase in the treatment of leukemia and solid tumors in 131 children. Cancer 1970; 25:306–320.

    PubMed  CAS  Google Scholar 

  82. Capizzi R, Bertino J, Skeel R, et al. L-asparaginase: Clinical, biochemical, pharmacological, and immunological studies. Ann Int Med 1971; 74:893–901.

    PubMed  CAS  Google Scholar 

  83. Ho D, Brown N, Yen A, et al. Clinical pharmacology of polyethylene glycol 1-asparaginase. Drug Metab Dispos 1986; 14:349–352.

    PubMed  CAS  Google Scholar 

  84. Berg S, Balis F, McCully C, et al. Pharmacokinetics of peg-1-asparaginase and plasma and cerebrospinal fluid 1-asparagine concentrations in the rhesus monkey. Cancer Chemother Pharmacol 1993; 32:310–314.

    Article  PubMed  CAS  Google Scholar 

  85. Riccardi R, Holcenberg J, Glaubiger D, et al. L-asparaginase pharmacokinetics and asparagine levels in cerebrospinal fluid of rhesus monkeys and humans. Cancer Res 1981; 41:4554–4558.

    PubMed  CAS  Google Scholar 

  86. Collins J. Pharmacokinetics of intraventricular admininstration. J Neuro-Oncol. 1983; 1:283–291.

    Article  CAS  Google Scholar 

  87. Blasberg R, Patlak C, Shapiro W. Distribution of methotrexate in the cerebrospinal fluid and brain after intraventricular administration. Cancer Treat Rep 1977; 61:633–641.

    PubMed  CAS  Google Scholar 

  88. Chamberlain MC, Corey BJ. Leptomeningeal metastases: 111indium-dtpa CSF flow studies. Neurology 1991; 41:1765–1769.

    PubMed  CAS  Google Scholar 

  89. Arndt C, Colvin O, Balis F, et al. Intrathecal administration of 4-hydroperoxycyclophosphamide in rhesus monkeys. Cancer Res 1987; 47:5932–5934.

    PubMed  CAS  Google Scholar 

  90. Berg SL, Balis FM, Zimm S, et al. Phase i/ii trial and pharmacokinetics of intrathecal diaziquone in refractory meningeal malignancies. J Clin Oncol 1992; 10:143–148.

    PubMed  CAS  Google Scholar 

  91. Bigner DD, Brown M, Coleman RE, et al. Phase i studies of treatment of malignant gliomas and neoplastic meningitis with 131i-radiolabeled monoclonal antibodies anti-tenascin 81c6 and anti-chondroitin proteoglycan sulfate mel-14 f (ab')2—a preliminary report. J Neurooncol 1995; 24:109–122.

    Article  PubMed  CAS  Google Scholar 

  92. Blaney S, Balis F, Murphy R, et al. A phase i study of intrathecal mafosfamide in patients with refractory meningeal malignancy. Proc Am Soc Clin Oncol 1992; 11:274.

    Google Scholar 

  93. Blaney S, Horowitz M, Kun L, et al. A new approach to the treatment of infants with CNS tumors. Society Neuro-Oncology. Chicago, IL; 2000

    Google Scholar 

  94. Brown MT, Coleman RE, Friedman AH, et al. Intrathecal 131i-labeled antitenascin monoclonal antibody 81c6 treatment of patients with leptomeningeal neoplasms or primary brain tumor resection cavities with subarachnoid communication: Phase I trial results. Clin Cancer Res 1996; 2:963–972.

    PubMed  CAS  Google Scholar 

  95. Hall WA, Fodstad O. Immunotoxins and central nervous system neoplasia. J Neurosurg 1992; 76:1–12.

    PubMed  CAS  Google Scholar 

  96. Kemshead JT, Hopkins KI, Chandler CL. Treatment of diffuse leptomeningeal malignancy by intrathecal injection of 131i radioimmunoconjugates. Recent Results Cancer Res 1996; 141:145–158.

    PubMed  CAS  Google Scholar 

  97. Kemshead JT, Hopkins K, Pizer B, et al. Dose escalation with repeated intrathecal injections of 131i-labelled mabs for the treatment of central nervous system malignancies. Br J Cancer 1998; 77:2324–2330.

    PubMed  CAS  Google Scholar 

  98. Moseley RP, Papanastassiou V, Zalutsky MR, et al. Immunoreactivity, pharmacokinetics and bone marrow dosimetry of intrathecal radioimmunoconjugates. Int J Cancer 1992; 52:38–43.

    PubMed  CAS  Google Scholar 

  99. Slavc I, Schuller E, Czech T, et al. Intrathecal mafosfamide therapy for pediatric brain tumors with meningeal dissemination. J Neurooncol 1998; 38:213–218.

    Article  PubMed  CAS  Google Scholar 

  100. Youle RJ. Immunotoxins for central nervous system malignancy. Semin Cancer Biol 1996; 7:65–70.

    Article  PubMed  CAS  Google Scholar 

  101. Bleyer W, Poplack D, Simon R. "concentration x time" methotrexate via a subcutaneous reservoir: A less toxic regimen for intraventricular chemotherapy of central nervous system neoplasms. Blood 1978; 51:835–842.

    PubMed  CAS  Google Scholar 

  102. Chamberlain M, Dirr L. Involved field radiotherapy and intra-Ommaya methotrexate/arac in patients with aids-related lymphomatous meningitis. J Clin Oncol 1993; 11:1978–1984.

    PubMed  CAS  Google Scholar 

  103. Chamberlain M, Kormanik P. Leptomeningeal metastases due to melanoma: Combined modality therapy. Int J. Oncol 1996; 9:505–510.

    Google Scholar 

  104. Chamberlain M, Kormanik P. Carcinomatous meningitis secondary to breast cancer: Combined modality therapy. J Neurooncol 1997; 35:55–64.

    Article  PubMed  CAS  Google Scholar 

  105. Chamberlain M, Kormanik P. Carcinomatous meningitis secondary to non-small cell lung cancer: Combined modality therapy. Arch Neurol 1998; 55:506–512.

    Article  PubMed  CAS  Google Scholar 

  106. Chamberlain M, Kormanik P. Non-aids related lymphomatous meningitis: Combined modality therapy. Neurology 1997; 49:1728–1731.

    PubMed  CAS  Google Scholar 

  107. Chamberlain M, Kormanik P. Lymphomatous meningitis in immunocompromised patients: Combined modality therapy. Oncol Rep 1998; 5:521–525.

    PubMed  CAS  Google Scholar 

  108. Chamberlain M, Kormanik P. Complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases. J Neurosurg 1997; 87:694–699.

    Article  PubMed  CAS  Google Scholar 

  109. Lishner M, Perrin RG, Feld R, et al. Complications associated with Ommaya reservoirs in patients with cancer. The Princess Margaret Hospital experience and a review of the literature. Arch Intern Med 1990; 150:173–176.

    Article  PubMed  CAS  Google Scholar 

  110. Price R. Therapy related central nervous system diseases in children with acute lymphocytic leukemia. In: Mastrangelo R, Poplack D, Riccardi R, eds. Central nervous system leukemia. Boston: Martinus Nijhoff Publishers; 1983:71–81.

    Google Scholar 

  111. Ochs J. Neurotoxicity due to central nervous system therapy for childhood leukemia. Am J Ped Hematol-Oncol 1989; 11:93–105.

    Article  CAS  Google Scholar 

  112. Pochedly C. Prevention of meningeal leukemia. Review of 20 years of research and current recommendations. Hematol Oncol Clin North Am 1990; 4:951–969.

    PubMed  CAS  Google Scholar 

  113. Whiteside J, Philips F, Dargeon H, et al. Intrathecal amethopterin in neurological manifestations of leukemia. Arch Int Med 1958; 101:279–285.

    CAS  Google Scholar 

  114. Sullivan M, Vietti T, Fernbach D, et al. Clinical investigations in the treatment of meningeal leukemia: Radiation therapy regimens vs. Conventional intrathecal methotrexate. Blood 1969; 34:301–319.

    PubMed  CAS  Google Scholar 

  115. Bleyer W, Drake J, Chabner B. Neurotoxicity and elevated cerebrospinal fluid methotrexate concentration in meningeal leukemia. New Engl J Med 1973; 289:770–773.

    Article  PubMed  CAS  Google Scholar 

  116. Addegio J, Ridgway D, Bleyer W. The acute management of intrathecal methotrexate overdose: Pharmacologic rationale and guidelines. J Pediatr 1981; 98:825–828.

    Article  Google Scholar 

  117. Adamson PC, Balis FM, McCully CL, et al. Rescue of experimental intrathecal methotrexate overdose with carboxypeptidase-g2. J Clin Oncol 1991; 9:670–674.

    PubMed  CAS  Google Scholar 

  118. Bleyer W, Poplack D. Intraventricular versus intralumbar methotrexate for central nervous-system leukemia: Prolonged remission with the Ommaya reservoir. Med Pediatr Oncol 1979; 6:207–213.

    PubMed  CAS  Google Scholar 

  119. Bleyer W, Coccia P, Sather H, et al. Reduction in the incidence of central nervous system leukemia with a pharmacokinetically derived intrathecal methotrexate dosage regimen. J Clin Oncol 1983; 1:317–325.

    PubMed  CAS  Google Scholar 

  120. Saiki J, Thompson S, Smith F, et al. Paraplegia following intrathecal chemotherapy. Cancer 1972; 29:370–374.

    PubMed  CAS  Google Scholar 

  121. Strong J, Collins J, Lester C, et al. Pharmacokinetics of intraventricular and intravenous n,n′,n″-triethylenethiophosphoramide (thiotepa) in rhesus monkeys and humans. Cancer Res 1986; 46:6101–6104.

    PubMed  CAS  Google Scholar 

  122. Bleyer WA. Intrathecal depot cytarabine therapy: A welcome addition to the therapeutic armamentarium. Clin Cancer Res 1999; 5:3349–3351.

    PubMed  CAS  Google Scholar 

  123. Blaney SM, Heideman R, Berg S, et al. Phase I clinical trial of intrathecal topotecan in patients with neoplastic meningitis. Submitted.

    Google Scholar 

  124. Dedrick R, Zaharko D, Bender R, et al. Pharmacokinetic considerations on resistance to anticancer drugs. Cancer Chemother Rep 1975; 59:795–804.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Norris Cancer Center, University of Southern California, Los Angeles, Ca., 90089

    Stacey L. Berg M.D. & Marc C. Chamberlain M.D.

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  1. Stacey L. Berg M.D.
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  2. Marc C. Chamberlain M.D.
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Editors and Affiliations

  1. Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021

    Lauren E. Abrey M.D.

  2. Department of Neurology, University of Southern California, Norris Comprehensive Cancer Center and Hospital, Los Angeles, CA, 90033

    Marc C. Chamberlain M.D.

  3. Departments of Neurosurgery, Bioengineering & Molecular Genetics, University of Illinois at Chicago, Chicago, IL, 60612

    Herbert H. Engelhard M.D., PhD.

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Berg, S.L., Chamberlain, M.C. (2005). Current Treatment of Leptomeningeal Metastases: Systemic Chemotherapy, Intrathecal Chemotherapy and Symptom Management. In: Abrey, L.E., Chamberlain, M.C., Engelhard, H.H. (eds) Leptomeningeal Metastases. Cancer Treatment and Research, vol 125. Springer, Boston, MA. https://doi.org/10.1007/0-387-24199-X_8

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  • DOI: https://doi.org/10.1007/0-387-24199-X_8

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-24198-2

  • Online ISBN: 978-0-387-24199-9

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