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Systemic therapy
CNS-directed therapy
Getting treatment past the blood-brain barrier, by route, by drug choice, or by radiation.
Delivered at a partner unit
What it is
Most cancer drugs do not enter the brain and spinal fluid in useful concentrations. CNS-directed treatment works around that: intrathecal chemotherapy given by lumbar puncture or Ommaya reservoir, high-dose drugs that do cross, CNS-penetrant targeted agents, and radiation to the brain or the whole neuraxis.
In leukaemia and lymphoma this is often prophylactic, treating a site that has no visible disease because the risk of relapse there is high enough to justify it.
When it is used
- CNS prophylaxis in acute leukaemia and high-risk lymphoma
- Leptomeningeal disease
- Brain metastases from lung, breast or melanoma
- Primary CNS lymphoma
How the decision is made
- Whether the goal is prophylaxis or treatment of established disease, the intensity differs completely.
- Route: intrathecal, systemic high-dose, a CNS-penetrant targeted drug, or radiation.
- The cognitive cost of whole-brain radiation against the alternatives, honestly stated.
Planned here; intrathecal and radiation delivery at partner units with the required facilities.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- Board review of CNS risk and route
- Neurology and neuro-oncology input on the case
- Written plan including cognitive risk
- Response and toxicity review between cycles
Performed and billed elsewhere
- Lumbar puncture and intrathecal administration
- Ommaya placement
- Cranial radiotherapy
- Headache, nausea and fatigue are common after intrathecal treatment. New weakness, seizures or confusion need same-day assessment.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- Is this prophylaxis or treatment of something you can see?
- What will this do to my memory and concentration?
- Are there drug options that reach the brain without radiation?
- How many treatments?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Leukaemia
Acute and chronic leukaemias. ALL, AML, CLL, CML
Lymphoma
Hodgkin and non-Hodgkin lymphoma
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Breast cancer
Including hormone-receptor positive, HER2-positive and triple-negative disease
Brain & CNS tumours
Glioma, meningioma, and other central nervous system tumours
Skin cancer & melanoma
Melanoma, basal cell and squamous cell carcinoma
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.