Child's Nervous System

, Volume 24, Issue 5, pp 581–585

Intrathecal chemotherapy for refractory disseminated medulloblastoma

  • Junichi Yoshimura
  • Kenichi Nishiyama
  • Hiroshi Mori
  • Hideaki Takahashi
  • Yukihiko Fujii
Original Paper

DOI: 10.1007/s00381-007-0538-8

Cite this article as:
Yoshimura, J., Nishiyama, K., Mori, H. et al. Childs Nerv Syst (2008) 24: 581. doi:10.1007/s00381-007-0538-8

Abstract

Objective

To analyze the effect of intrathecal (IT) chemotherapy for disseminated medulloblastoma.

Materials and methods

Twenty-one patients received IT chemotherapy using the chemotherapeutic agents of methotrexate (MTX) and nitrosoureas (ACNU, MCNU) including nine patients for residual leptomeningeal lesions after initial surgery and radiation, and 12 for a recurrence with leptomeningeal dissemination. Of these 21 patients, 12 received a lumbar and/or ventricular bolus injection of the chemotherapeutic agents, one received the ventriculolumbar perfusion of the agents, and eight received both the perfusion and bolus injection. The doses ranged from 6–7 mg/m2 of ACNU for perfusion and 3–3.5 mg/m2 of ACNU, MCNU, or MTX for the bolus injection, and the cycles were administered from 3 to 12 times for perfusion and from 5 to 54 times for the bolus injection. The effects of chemotherapy were assessed by both radiological and cytological examinations, and the clinical symptoms were also assessed. Radiological and/or cytological responses were observed in 10 of 21 patients (47.6%), including seven cases demonstrating a complete remission. The 5-year overall survival rate and 5-year survival rate after dissemination were 61.5 and 46.4%, respectively. Five patients who received a lumbar bolus injection of nitrosoureas experienced paraplegia and double incontinence. One patient who received a ventricular injection of nitrosoureas experienced truncal ataxia.

Conclusion

IT chemotherapy was found to be effective in some cases with refractory disseminated medulloblastoma and it seems to be an appropriate treatment choice for leptomeningeal recurrence. However, the frequent bolus injections of nitrosoureas should be avoided to prevent the side effects.

Keywords

MedulloblastomaDisseminationIntrathecal (IT) chemotherapyVentriculolumbar perfusion chemotherapyNitrosourea (ACNUMCNU)Methotrexate

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Junichi Yoshimura
    • 1
  • Kenichi Nishiyama
    • 1
  • Hiroshi Mori
    • 2
  • Hideaki Takahashi
    • 1
  • Yukihiko Fujii
    • 1
  1. 1.Department of Neurosurgery, Brain Research InstituteUniversity of NiigataNiigata CityJapan
  2. 2.Division of Pediatric Neurosurgery, Jikei University HospitalJikei Women’s and Children’s Medical CenterMinato-kuJapan