Brain Tumor Res Treat.  2019 Oct;7(2):85-91. 10.14791/btrt.2019.7.e33.

Efficacy of Slow Rate Ventriculolumbar Perfusion Chemotherapy for Leptomeningeal Carcinomatosis: Interim Result of a Phase II Study

Affiliations
  • 1Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • 2Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea. nsghs@ncc.re.kr
  • 3Biometric Research Branch, National Cancer Center, Goyang, Korea.
  • 4Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea.

Abstract

BACKGROUND
To evaluate the efficacy of modified ventriculolumbar perfusion (VLP) chemotherapy with methotrexate on leptomeningeal carcinomatosis in terms of symptomatic response and side effects.
METHODS
Previous infusion rate of 20 mL/h was reduced to 15 mL/h for the purpose of decreasing constitutional side effects of VLP such as nausea/vomiting, insomnia and confusion. The primary outcome was the response rate of increased intracranial pressure (ICP), and the secondary outcome was the occurrence of side effects compared to previous 20 mL/h trial. This interim analysis to validate the reduced infusion rate is not to affect the original effect of VLP chemotherapy.
RESULTS
All forty-seven patients were enrolled including 22 patients with increased ICP. Thirteen patients out of these (59%) got normalized ICP after VLP chemotherapy. Moderate to severe (grade 2-3) confusion was observed in 3 patients (6%) and it was significantly reduced compared to those (23%) in the VLP 20 mL/h (p=0.017). Grade 2-3 nausea/vomiting was also reduced from 64% to 45% but failed to reach statistical significance (p=0.08). Median overall survival (OS) was 5.3 months (95% confidence interval, 3.55-7.05) and patients OS, who received maintenance VLP was significantly prolonged compared to patients who underwent induction VLP only (5.8 vs. 3.4 months, p=0.025).
CONCLUSION
VLP of reduced perfusion rate (15 mL/h) showed compatible control rate of increased ICP at this interim analysis. Decreased moderate to severe side effects and prolonged OS in patients received maintenance VLP encourage us to evaluate the effectiveness of this trial further.

Keyword

Intraventricular infusion; Chemotherapy; Leptomeningeal carcinomatosis; Methotrexate; Perfusion

MeSH Terms

Drug Therapy*
Humans
Infusions, Intraventricular
Intracranial Pressure
Meningeal Carcinomatosis*
Methotrexate
Perfusion*
Sleep Initiation and Maintenance Disorders
Methotrexate
Full Text Links
  • BTRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error