Leptomeningeal carcinomatosis is a serious complication leading to a fatal outcome in patients with gastric cancer. We tried to treat leptomeningeal carcinomatosis from gastric cancer with intrathecal chemotherapy using methotrexate (MTX)and cytosine arabinoside(Ara-C). We described and discussed the therapeutic strategy. Six patients with leptomeningeal carcinomatosis from gastric cancer were admitted in our institution from March 2004 to July 2007. Three of 6 patients were accepted for intrathecal chemotherapy. They received intraventricular injections of MTX(5 mg)and Ara-C(20 mg)through the Ommaya reservoir. The other 3 patients who rejected the therapy were conservatively treated with betamethasone, carbamazepine and glyceol. Two of the intrathecal chemotherapy group received whole-brain radiotherapy after the initial intrathecal chemotherapy. The mean survival time was 122.3 days(median survival time 35.0 days). The survival of the intrathecal chemotherapy group was from 39 to 367 days, whereas the survival of the conservative treatment group was from 10 to 31 days. The intrathecal chemotherapy improved not only survival but also clinical symptoms dramatically. Intrathecal chemotherapy is thus recommended for leptomeningeal carcinomatosis from gastric cancer.
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