The Role of Intra-cerebrospinal Fluid Treatment and Prophylaxis in Patients With Solid Tumors

Proposal for a pilot phase II single-arm, open-label clinical trial of capecitabine and liposomal cytarabine for the treatment of newly diagnosed neoplastic meningitis with or without central nervous system metastases in patients with breast cancer.

(A) Proposal for an intra-cerebrospinal fluid (CSF) prophylaxis trial in patients with brain metastases from breast cancer. Stratification for: CSF cytology (positive v negative v uncertain); tumor site (posterior fossa v cerebral hemispheres); surgical resection (yes v no); and vertebral metastases (yes v no). (B) Proposal for a CSF prophylaxis trial in patients with brain metastases from breast cancer. CR, complete response; PR, partial response; MRI, magnetic resonance imaging; RPA, recursive partitioning analysis (used for prognostic classification); S, surgery; SRS, stereotactic radiosurgery; WBRT, whole-brain radiation therapy.

Proposal for a pilot clinical trial assessing whether chemoprophylaxis reduces the incidence of neoplastic meningitis in patients with posterior fossa central nervous system metastases who undergo surgical resection. CSF, cerebrospinal fluid; EVD, extra vascular drainage; IHC, immunohistochemistry; MRI, magnetic resonance imaging.