title: Continuous intrathecal administration of 5-fluoro-2'-deoxyuridine for the treatment of neoplastic meningitis.
abstract: OBJECTIVE
  Previously, we reported a good clinical treatment effect of intrathecal chemotherapy by repeated bolus administration of 5-fluoro-2'-deoxyuridine (FdUrd) for neoplastic meningitis (NM). Moreover, we detected no side effects or neurotoxicity despite the long-term repetition of intrathecal administration. On the basis of these findings, continuous intrathecal chemotherapy (CIC) with FdUrd for patients with NM was attempted using a simple pump system. We evaluated the usefulness of CIC with FdUrd for the treatment of NM.
  
  
  METHODS
  A total of 25 patients were enrolled in this study. FdUrd (1.0 mg/d) was administered using a balloon pump system. CIC was continued as long as possible. Eight patients received whole-brain irradiation (3 Gy x 10) simultaneously with CIC. The effects of the treatment were analyzed in terms of improvement in neurological signs and symptoms and the findings of ventricular and lumbar cerebrospinal fluid analysis 2 and 4 weeks after CIC was initiated and on magnetic resonance imaging scans 2 months after CIC began.
  
  
  RESULTS
  No apparent toxicity has been observed to date. Evidence of a cerebrospinal fluid response was observed in 13 patients. Headache and nausea were improved in all patients, and cranial nerve impairment was improved in 12 patients. A magnetic resonance imaging response was observed in only 5 patients. Overall response was observed in 15 patients when cases of stable disease were excluded from the responding cases. Survival time from the commencement of CIC (mean +/- standard error of the mean) was 255 +/- 30 days in 25 patients.
  
  
  CONCLUSIONS
  This therapy may be useful, especially as a maintenance therapy for NM.
authors.affiliation: Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. nakagawa-hi@mc.pref.osaka.jp
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Miyahara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kohichi
authors.initials: K
authors.lastname: Wada
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tamura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000097:blood / Q000134:cerebrospinal fluid; D001932:Brain Neoplasms / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems / Q000295:instrumentation / Q000379:methods; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage* / Q000097:blood / Q000134:cerebrospinal fluid; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005467:Floxuridine