Intra-arterial infusion of high dose methotrexate therapy in recurrent gliomas

Intra-arterial high dose methotrexate (MTX) infusion therapy for ACNU resistant recurrent gliomas was reported. MTX was administered 16 times to 6 patients. In all cases, 20% mannitol was infused to produce a reversible osmotic blood brain barrier disruption. Dosage of infused MTX was 1,000-2,000 mg per an artery. One case revealed a complete response on CT. Another case showed an intratumoral necrosis. Intra-arterial high dose MTX infusion yielded high arterial and cerebrospinal fluid concentration of MTX. No critical complications were experienced. Dosage of MTX, an interval between the therapies and proper timing to start leucovorin rescue will be discussed.