Chemotherapy administered in conjunction with osmotic blood-brain barrier modification in patients with brain metastases

Clinical experience in seven patients with systemic malignancies (breast, lung and testicular) metastatic to the central nervous system treated with chemotherapy given in association with reversible osmotic blood-brain barrier modification is reviewed. A combination chemotherapy regimen including intra-arterial methotrexate, intravenous cytoxan and oral procarbazine in conjunction with intra-arterial mannitol infusions was successfully carried out with minimal toxicity. The results in these patients demonstrate some therapeutic efficacy to the increased drug delivery achieved with this technique. Although suggestive, additional studies will be required to confirm that barrier modification is a key parameter in such efficacy.