Abelson H T, Kufe D W, Skarin A T, Major P, Ensminger W, Beardsley G P, Canellos G P
Cancer Treat Rep. 1981;65 Suppl 1:137-40.
Thirteen patients with primary and metastatic CNS tumors have been treated with methotrexate (MTX) using three different approaches: (a) high-dose MTX with leucovorin (LV) rescue; (b) high-dose MTX with carboxypeptidase (CPDG) rescue; and (c) intraventricular administration of low doses of MTX for extended periods (concentration X time [CXT]). Eleven patients had central nervous system (CNS) lymphoma (one primary, one patient had recurrent medulloblastoma, and another patient had metastatic breast carcinoma. All 13 patients received high-dose MTX-LV rescue, while 3 patients were subsequently given MTX-CPDG. One patient received MTX by all three modalities. In patients with CNS lymphomas, complete responses (45%) and partial responses (36%) produced CNS disease-free intervals ranging from 1 to 23+ months. Survival for the complete responders has thus far ranged from 2.5 to 35 months, while the partial responders survived from 3 to 5 months. Two patients failed to respond and survived 2.5 and 3 months. Responses were obtainable with high-dose MTX-CPDG in patients resistant to MTX-LV. One patient who became sensitized to CPDG subsequently responded to MTX by intraventricular CXT administration. Thus, MTX can be effectively administered to patients with CNS tumors by several different approaches.
13例原发性和转移性中枢神经系统肿瘤患者接受了甲氨蝶呤（MTX）治疗，采用了三种不同方法：（a）大剂量MTX联合亚叶酸（LV）解救；（b）大剂量MTX联合羧肽酶（CPDG）解救；（c）长期脑室内给予低剂量MTX（浓度×时间[CXT]）。11例患者患有中枢神经系统（CNS）淋巴瘤（1例原发性，1例复发性髓母细胞瘤，另1例转移性乳腺癌）。所有13例患者均接受了大剂量MTX-LV解救，其中3例患者随后给予了MTX-CPDG。1例患者接受了所有三种治疗方式。在患有CNS淋巴瘤的患者中，完全缓解（45%）和部分缓解（36%）产生的CNS无病生存期为1至23 +个月。完全缓解者的生存期迄今为2.5至35个月，部分缓解者存活3至5个月。2例患者无反应，分别存活2.5个月和3个月。对MTX-LV耐药的患者使用大剂量MTX-CPDG可获得反应。1例对CPDG敏感的患者随后通过脑室内CXT给药对MTX产生反应。因此，MTX可通过几种不同方法有效地应用于CNS肿瘤患者。
