[Medical palliative therapy of meningiosis carcinomatosa of breast carcinoma with dissociated response in lumbar methotrexate instillation].

CASE REPORT: We report the case of a 51-year-old woman who suffered from breast cancer and developed meningeal carcinomatosis of the brain stem with deafness and blindness. Radiotherapy was given but led to remarkable deterioration of the condition and strong headache. We performed intrathecal therapy with methotrexate (MTX) via lumbar application. Under this regimen, the patient immediately showed complete improvement of the headache and a partial recovery of hearing. There were no side effects apart from alopecia. MTX concentrations in liquor and blood were remarkably inconsistent. 4 weeks after MTX therapy, MRT revealed partial remission of the meningiosis of the brain stem but progression on both hemispheres. 5 weeks after the beginning of the intrathecal therapy, the patient died.

CONCLUSION: Despite pharmacokinetic problems we consider lumbar intrathecal therapy with MTX a suitable procedure for patients with leptomeningeal carcinomatosis and poor performance status.