Cytostatic treatment of meningeal blastoses

Intrathecal treatment with MTX was attempted in patients with diffuse meningeal blastoses. As a rule, symptoms and clinical findings improved rapidly. As objective parameters, the differential cell pictures of the CSF showed dissimilar results during therapy (25 mg MTX weekly i.t.). In leukoses (n = 10) and malignant lymphomas (n = 12), the CSF could be cleared with three exceptions which concerned differentiated tumors. The success was similarly good with meningeal dissemination of a seminoma. Meningeal carcinoses with mammary carcinoma (n = 7) and melanoma (n = 2) showed dissimilar results. No alteration of the cytograms of four bronchial carcinomas and one colon carcinoma was demonstrable. Besides the growth form, the degree of differentiation appears to be decisive for the success of therapy. The labeling index appears to be a useful indicator. Since symptoms and clinical findings often markedly improve even when a success cannot be objectively detected cytologically, an attempt at therapy is always to be recommended.