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Central nervous system imaging demonstrated interrupted cerebrospinal fluid flow(13 patients),parenchymal brain metastases(9),subarachnoid nodules(8),hydrocephalus(5),and epidural spinal cord compression(2). Cytological responses were seen in 17 patients to first-line chemotherapy, 8 to second-line chemotherapy,and 2 to third-line chemotherapy.Treatment- related toxic effects included 20 patients with aseptic meningitis(grade 2 in 16;grade 3 in 4)and 12 patients with grade 3 or 5 thrombocytopenia or neutropenia(4 related to intraventricular chemotherapy).Median survival was 5 months(range,1-12 months).Nineteen patients died of progressive LM or combined LM and systemic disease progression.Patients with persistent interruption of cerebrospinal fluid flow fared worse than patients with normal cerebrospinal fluid flow(median survival,4 vs 6 months;P<.05). |
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