Chemotherapy Alone

Chemo Secrets From a Breast Cancer Survivor

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Chemotherapy approaches have included using MTX as a single agent, combining MTX with other drugs that penetrate the BBB, and administering high-dose chemotherapy and stem cell rescue in patients who respond to induction MTX-based regimens. These studies are outlined in Table 58.2 and demonstrate a wide range of OS. The striking difference compared to combined modality treatment appears to be the minimal neurotoxicity.

While the majority of studies have focused on using combinations of chemotherapy agents that penetrate the BBB, other investigators developed administration strategies that improve drug delivery to the brain. With the patient under general anesthesia, the femoral artery is catheterized and an osmotic agent, mannitol, can be used to temporarily disrupt the BBB. This is followed by the intravenous and intraarterial infusion of chemotherapy, and is repeated monthly for up to 12 cycles in responding patients.59 One

Table 58.2 Results of selected trials of MTX based chemotherapy alone in the treatment of PCNSL

Chemotherapy (Systemic) MTX dose Other drugs

IT Median chemo Institution Age (yr) N

Median PFS (mo)

Median OS (mo)

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Neurotoxicity Reference

8g/m2 X 4 None 3.5 g/m2 X 13

No Multi 59 59

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