Treatment of neoplastic meningitis with intraventricular thiotepa and methotrexate

Twenty-five patients with involvement of the meninges by disseminated cancers were treated weekly with intraventricular thiotepa (10 mg) and methotrexate (10 mg) and with radiation therapy. Twenty-two of the 25 patients were clinically improved or stable. Malignant cells were cleared from the cerebrospinal fluid in 76% of the patients. Myelosuppression was the dose-limiting toxic effect, and neurotoxicity occurred in three patients. Combination chemotherapy employing thiotepa and methotrexate is a safe and effective treatment for neoplastic meningitis.