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Cho KM, Kim YJ, Kim SH, Kim JW, Lee JO, Han JH, Lee KW, Kim JH, Kim CY, Bang SM, Kim IA, Kim JS, Lee JS. Salvage Treatment with Intracerebrospinal Fluid Thiotepa in Patients with Leptomeningeal Metastasis After Failure of Methotrexate-based Treatment. Anticancer Res 2015; 35:5631-5638. [PMID: 26408736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the efficacy of intracerebrospinal fluid (intra-CSF) thiotepa in patients with leptomeningeal metastasis (LM) after failure of a methotrexate-based treatment. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients with LM who received 10 mg of intra-CSF thiotepa twice a week. RESULTS Out of 40 patients, 25 were females (63%), and 31 (78%) had an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2. Fourteen out of the 30 evaluable patients (47%) had a cytological response to intra-CSF thiotepa. The median overall survival (OS) after treatment with thiotepa was 19.4 weeks (95% confidence interval (CI)=15.3-23.5). Grade 3 toxicities were thrombocytopenia (N=2), bacterial meningitis (N=2), and pneumonia (N=1). According to a multivariate analysis, an ECOG PS ≥2 (hazard ratio (HR)=5.11, 95% CI=1.39-18.80, p=0.014), clinical improvement (HR=0.09, 95% CI=0.03-0.29, p<0.001), and radiation for LM after intra-CSF thiotepa (HR=0.33, 95% CI=0.11-0.97, p=0.043) were independently associated with survival. CONCLUSION Intra-CSF thiotepa seems to be a meaningful salvage treatment for patients with LM whose disease progresses after a methotrexate-based treatment.
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Affiliation(s)
- Kyoung-Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Ah Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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