Intrathecal Injection Of Different Doses Of Methotrexate For The Treatment Of Meningeal Cancer: Clinical Observation And Early Exploration Of Meningeal Carcinous Tumor Microenvironment

Objective: The aim of this study is to evaluate the clinical efficacy,safety and survival time of intrathecal chemotherapy in the treatment of meningeal carcinomatosis,so as to improve the level of diagnosis and treatment,and explore the tumor microenvironment of meningeal carcinomatosis.Methods:Clinical data and laboratory examination of cerebrospinal fluid in 72 patients with meningeal carcinomatosis were analyzed retrospectively.And we analyze the adverse reactions and prognosis of intrathecal injection of different doses of MTX,as well as the correlation between activated monocyte nucleus in cerebrospinal fluid of patients with meningeal carcinomatosis and lumbar puncture pressure,protein,tumor cell content and KPS score.Results: In 72 patients,the clinical symptom remission rate was higher in the intrathecal 15 mg MTX group(71.4%)than in the 10 mg group(36.8%)(P=0.005),but there was no significant difference in cerebrospinal fluid pressure,routine and biochemical changes.During hospitalization,86.4% of patients with meningeal carcinomatosis had no symptoms after intrathecal injection,6.1% had nausea,vomiting,fever,sweat,or epilepsy,and 7.6% of patients had a decrease in white blood cells,but both received radiotherapy and chemotherapy.The overall median survival of this group of patients was15.57 weeks.The survival rate of intrathecal chemotherapy combined with targeted drugs was higher than that of patients without combination of targeted drugs(P=0.008).The spearman correlation coefficient between the content of tumor cells and the content of activated monocytes in cerebrospinal fluid was r =-0.337,P = 0.024,which was statistically significant.Conclusion:1.Intrathecal chemotherapy is a safe and effective treatment for meningeal cancer.And intrathecal injection of 15 mg methotrexate combined with targeted drugs is more effective in relieving clinical symptoms and prolonging the lifetime of patients.2.The tumor microenvironment also exists in the cerebrospinal fluid of meningococcal cancer patients.And the content of tumor cells in cerebrospinal fluid is related to the content of activated monocytes.