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Original Article

Intrathecal dexamethasone and methotrexate

treatment of neoplastic meningitis from solid

tumors

Wen‑Jing Lv, Jun‑Ying He, Yue‑Li Zou, Ya‑Juan Liu, Qin‑Qin Zhang, Xin Liu, Hui Bu
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China.

ABSTRA CT

Aim: Neoplastic meningitis (NM) from solid tumors is an advanced malignancy with poor prognosis. Intrathecal chemotherapy is a
reliable treatment, and we have obtained some experiences in the treatment of NM with intrathecal dexamethasone and methotrexate (IT
DXM and MTX). Methods: Retrospective study of 23 patients with NM from lung cancer (n = 11), breast cancer (n = 3), gastric
cancer (n = 1), malignant melanoma (n = 1), unknown cancer (n = 7) was conducted. Among these patients, eight received IT DXM
and MTX treatment, and 15 patients were placed into a palliative care group. Overall survival (OS) was compared, and the patients’
characteristics, symptoms, and some laboratory examinations were analyzed to find the risk factors affecting OS. Results: OS of IT
DXM and MTX group was significantly longer than that of the palliative care group (P = 0.01). The median survival (MS) of palliative
care group was 7.53 weeks (5.50‑9.57; n = 15), and of the IT DXM and MTX group, 28.63 weeks (12.50‑44.75; n = 8); IT DXM
and MTX prolonged the OS of NM patients (regression coefficient = −2.923), with odds ratio (OR) being 0.054 (0.09‑0.323). Spinal
nerves damage decreased the OS (regression coefficient = 1.595), with OR being 4.928 (1.382‑17.579). Conclusion: IT DXM and
MTX have prolonged the patients’ MS, which could be used as a fundamental treatment of NM. Time of induction treatment should
be flexible and individualized, and induction treatment could restart when central nervous system relapse. Patients with spinal nerves
damage are apt to live shorter.

Key words: Clinical experiences, intrathecal dexamethasone and methotrexate, neoplastic meningitis

INTRODUCTION CSFC being 71-94%. [4-9] The survival of NM ranges from
8 to 16 weeks despite treatment. [10,11] Patients have a poor
Neoplastic meningitis (NM) is the leptomeningeal Karnofsky Performance Score (KPS), when diagnosed
dissemination of metastatic tumors; a devastating with either bulky central nervous system (CNS)
complication from solid tumors. The incidence of disease, abnormal CSF-flow study, multiple serious
NM has increased as patients are living longer due to neurological deficits, encephalopathy, and extensive
significant improvements in treatment options in the systemic cancer without good treatment options have
form of large molecule target agents. There are case poorer prognosis and need palliative care instead of
reports about cancers that don’t yet progress into NM, positive therapy. For an improved outcome, most
[9]
such as ovarian cancer, prostate cancer, and renal patients of NM need a combination of radiation therapy,
[2]
[1]
cancer. NM is clinically detected in 5-8% of the systemic chemotherapy, and intrathecal chemotherapy.
[3]
patients with cancers, while through autopsies NM Intrathecal chemotherapy is the main treatment of NM.
detected in 19% of the cancerous patients. Methotrexate, cytarabine, thiotepa, liposomal cytarabine
are the traditional intrathecal chemotherapy regimens.
Cerebrospinal fluid cytology (CSFC) is the gold standard
for determining NM, with the reported sensitivity of Intrathecal methotrexate has a long history of treating
NM. [12] Intrathecal methotrexate is now widely used to
Access this article online treat NM in the patients with those cancers with possible
Quick Response Code: metastasis to the CNS, such as gastric cancer, breast
Website: cancer, lymphoma, nonsmall-cell lung cancer, multiple
www.nnjournal.net
myeloma, as well as in the patients with cancers rarely
DOI: spreading to CNS-atypical neurofibroma and with
10.4103/2347-8659.160855 pancreatic cancer. [13-19] Though many physicians use
intrathecal cytotoxic drugs in combination with system

Corresponding Author: Dr. Hui Bu, Department of Neurology, The Second Hospital of Hebei Medical University, 215 West
Road of Peace, Shijiazhuang 050000, Hebei, China. E‑mail: sdlxlwj@126.com

162 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 163