Favorable response of intraommaya topotecan for leptomeningeal metastasis of neuroblastoma after intravenous route failure.
A 3-year-old male, diagnosed with stage 4 neuroblastoma, developed recurrent leptomeningeal metastasis after multi-modality treatment including multi-agent chemotherapy, surgery, high dose chemotherapy plus stem cell rescue, cis-retinoic acid and intravenous (IV) topotecan. He then received intraommaya (IO) topotecan three times weekly (maximum dose; 0.4 mg). A complete response was achieved by a resolution of malignant cells in cerebrospinal fluid and resolution leptomeningeal enhancement by brain MRI. Treatment toxicities included low-grade fever and minimal headache. The duration of treatment response from IO topotecan was 18 weeks. The survival time from CNS recurrence in this patient was 13 months. We suggest IO topotecan be considered for neoplastic meningitis of tumors with known sensitivity to topotecan.
Sirachainan
Nongnuch
N
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Visudtibhan
Anannit
A
Tuntiyatorn
Lojana
L
Pakakasama
Samart
S
Chuansumrit
Ampaiwan
A
Hongeng
Suradej
S
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D016543:Central Nervous System Neoplasms; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D007262:Infusions, Intravenous; D007278:Injections, Spinal; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000556:secondary*; D009447:Neuroblastoma / Q000188:drug therapy* / Q000473:pathology; D059004:Topoisomerase I Inhibitors; D019772:Topotecan / Q000008:administration & dosage*
D000970:Antineoplastic Agents; D059004:Topoisomerase I Inhibitors; D019772:Topotecan