title: Liposomal cytarabine in neoplastic meningitis from primary brain tumors: a single institutional experience.
abstract: Neoplastic meningitis (NM) is diagnosed in 1-2 % of patients with primary brain tumors. Standard treatment of NM includes single-agent or combination chemotherapy, with compounds such as methotrexate, thiotepa, and cytarabine (Ara-C) or its injectable, sustained-release formulation Depocyte(®). In this Report, we reported the data of efficacy and tolerability of an intrathecal Depocyte(®) regimen for patients presenting with NM from primary brain tumors. We described 12 patients with NM confirmed at magnetic resonance imaging (MRI) and with a positive cerebrospinal fluid (CSF) cytology. Patients were treated with repeated courses of intrathecal Depocyte(®) (once every 2 weeks for 1 month of induction therapy and as consolidation therapy on a monthly base in responding patients). Twelve patients (10 males and 2 females) were treated by our Institution. The diagnosis of primitive brain tumor was medulloblastoma in six patients, germinoma in two patients, pylocitic astrocytomas with spongioblastic aspects, teratocarcinoma, meningeal melanoma, and ependimoma in the other four patients. The total number of Depocyte(®) cycles ranged from one to nine. In 7/12 patients, there was clinical and/or radiological response after Depocyte(®), and the toxicity was moderate and transient, mainly due to the lumbar puncture procedure. In the two patients with germinoma, we observed a normalization of MRI Imaging and negativization of CSF with disappearance of the tumor cells. OS was 180 days (range 20-300, CI 95 %).
authors.affiliation: Neuro-Oncology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy, paolagaviani@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Gaviani
authors.forename: E
authors.initials: E
authors.lastname: Corsini
authors.forename: A
authors.initials: A
authors.lastname: Salmaggi
authors.forename: E
authors.initials: E
authors.lastname: Lamperti
authors.forename: A
authors.initials: A
authors.lastname: Botturi
authors.forename: A
authors.initials: A
authors.lastname: Erbetta
authors.forename: I
authors.initials: I
authors.lastname: Milanesi
authors.forename: F
authors.initials: F
authors.lastname: Legnani
authors.forename: B
authors.initials: B
authors.lastname: Pollo
authors.forename: A
authors.initials: A
authors.lastname: Silvani
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology*; D003561:Cytarabine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008081:Liposomes; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D008081:Liposomes; D003561:Cytarabine