title: Transitional cell carcinomatous meningitis after M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy.
abstract: The M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) regimen has been utilized at our two institutions to treat 17 patients with advanced stage transitional cell carcinoma of the bladder. We report 2 cases of carcinomatous meningitis resulting from metastatic transitional cell carcinoma which occurred in patients treated with M-VAC. Review of the literature suggests that our experience with central nervous system metastases is not unique, and that treatment of advanced stage transitional cell carcinoma of the bladder with M-VAC may enhance the incidence of meningeal metastases. Carcinomatous meningitis, although rare, is a rapidly fatal manifestation of metastatic transitional cell carcinoma if left untreated. However, prompt diagnosis and early aggressive therapy may result in palliation and stabilization of neurologic status. We review the pathophysiology, diagnosis, and treatment of transitional cell carcinomatous meningitis.
authors.affiliation: Urology Service, Walter Reed Army Medical Center, Washington, D.C.
authors.forename: J R
authors.initials: JR
authors.lastname: Bishop
authors.forename: J W
authors.initials: JW
authors.lastname: Moul
authors.forename: L
authors.initials: L
authors.lastname: Maldonado
authors.forename: D G
authors.initials: DG
authors.lastname: McLeod
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000139:chemically induced / Q000175:diagnosis / Q000556:secondary*; D008581:Meningitis / Q000139:chemically induced; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate