Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Neurology, Baoding No.1 Central Hospital, Baoding, China.
Jpn J Clin Oncol. 2021 Dec 1;51(12):1715-1722. doi: 10.1093/jjco/hyab155.
To investigate the clinical efficacy and safety of different doses of intrathecal methotrexate in the treatment of leptomeningeal carcinomatosis.
53 patients admitted to the Second Hospital of Hebei Medical University with leptomeningeal carcinomatosis were recruited. They were divided into two groups: 15-mg-group received 15 mg methotrexate intrathecally, while the other received 10 mg methotrexate. All patients were followed up to 31 December 2020 or until death. Primary endpoint was the response rate. Secondary endpoints were survival and safety. Treatment-related adverse events were recorded.
The intrathecal chemotherapy was regularly maintained in 42 cases. Most primary cancers were lung (60.4%), stomach (18.9%) or breast (5.7%). The clinical response rate was higher in the 15 mg group than the 10 mg group (62.5 vs. 34.5%, P = 0.042). In the 15 mg group, two cases showed myelosuppression and one case showed seizures. In the 10 mg group, one patient appeared fever, three patients appeared myelosuppression and one showed leukoencephalopathy. However, there were no serious irreversible adverse reactions in neither of the two groups. In terms of survival, the median survival was 15.7 weeks in the 15 mg group and 27.1 weeks in the 10 mg group (P = 0.116). Multivariate analysis showed that only targeted therapy improved the survival (P < 0.0001, HR = 5.386).
Increased dose of methotrexate did not prolong the overall survival, but it was more effective in relieving clinical symptoms with no increased adverse reactions. Targeted therapy might improve the survival.
探讨鞘内不同剂量甲氨蝶呤治疗脑膜癌病的临床疗效和安全性。
收集河北医科大学第二医院收治的 53 例脑膜癌病患者，分为 15mg 组（鞘内注射 15mg 甲氨蝶呤）和 10mg 组（鞘内注射 10mg 甲氨蝶呤），两组患者均随访至 2020 年 12 月 31 日或死亡。主要终点为缓解率，次要终点为生存和安全性。记录治疗相关不良反应。
42 例患者定期维持鞘内化疗。原发肿瘤以肺癌（60.4%）、胃癌（18.9%）和乳腺癌（5.7%）为主。15mg 组的临床缓解率高于 10mg 组（62.5%比 34.5%，P=0.042）。15mg 组中 2 例出现骨髓抑制，1 例出现癫痫。10mg 组中，1 例发热，3 例骨髓抑制，1 例出现脑白质病。但两组均无严重不可逆转的不良反应。在生存方面，15mg 组中位生存时间为 15.7 周，10mg 组为 27.1 周（P=0.116）。多因素分析显示，只有靶向治疗才能改善生存（P<0.0001，HR=5.386）。
增加甲氨蝶呤剂量并未延长总生存时间，但可更有效地缓解临床症状，且不增加不良反应。靶向治疗可能改善生存。
