title: Quality-of-life-adjusted survival comparison of sustained-release cytosine arabinoside versus intrathecal methotrexate for treatment of solid tumor neoplastic meningitis.
abstract: BACKGROUND
  The authors compared the quality of life of patients with solid tumor neoplastic meningitis treated in a controlled trial that compared conventional intrathecal methotrexate with a depot cytosine arabinoside liposomal injection (DepoCyt). The authors evaluated the trade-off between toxicity and improved clinical outcome.
  
  
  METHODS
  Quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis was used to evaluate data collected prospectively from a randomized clinical trial that compared DepoCyt with methotrexate. Sixty-one patients with confirmed solid tumor neoplastic meningitis were randomized to receive either methotrexate or DepoCyt.
  
  
  RESULTS
  Within the 12-month follow-up, the average patient in the DepoCyt arm (compared with the methotrexate arm) achieved 71 more days of neurologic progression-free survival and 52 more days of overall survival, but experienced slightly more days with toxicity. The DepoCyt regimen provided greater quality-adjusted survival regardless of the quality-of-life valuations placed on time with toxicity and time following disease progression (range, 44-79 days). This gain was significant (P < 0.05) for all patients except for those who placed a high relative value on time following disease progression.
  
  
  CONCLUSIONS
  The clinical benefits of DepoCyt offset a trend toward additional toxicity among patients with sold tumor neoplastic meningitis. The magnitude of the benefit depends on how the patient values time spent in toxicity and disease progression. The results of this analysis can be used at the bedside to make evidence-based individual treatment decisions.
authors.affiliation: Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA.
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Cole
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Glantz
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Jaeckle
authors.forename: Marc C
authors.initials: MC
authors.lastname: Chamberlain
authors.forename: John I
authors.initials: JI
authors.lastname: Mackowiak
mesh_terms: D000328:Adult; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D018450:Disease Progression; D006801:Humans; D007278:Injections, Spinal; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008581:Meningitis / Q000188:drug therapy* / Q000517:prevention & control*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D009369:Neoplasms / Q000473:pathology; D011788:Quality of Life; D016019:Survival Analysis
chemical_list: D003692:Delayed-Action Preparations; D003561:Cytarabine; D008727:Methotrexate