Intrathecal Chemotherapy: How It Works and What to Expect
If you’ve heard the term “intrathecal chemotherapy” and wondered what it means, you’re not alone. It’s a way of delivering cancer‑killing drugs directly into the spinal fluid, bypassing the blood‑brain barrier that blocks many medicines. By putting the medicine right where the tumor cells hide, doctors can hit them harder and often with lower overall doses.
Why Doctors Choose Intrathecal Delivery
Not every cancer needs this approach. It’s mainly used for cancers that spread to the brain or spinal cord, such as leukemia, lymphoma, or solid tumors that have a meningeal (lining) involvement. When cancer cells float in the cerebrospinal fluid (CSF), oral or IV drugs can’t get to them in sufficient amounts. Injecting directly into the CSF solves that problem.
Common drugs include methotrexate, cytarabine, and thiotepa. These agents are powerful but can be toxic if they circulate through the whole body at high levels. Giving them intrathecally lets doctors use a smaller amount while keeping the concentration high where it’s needed.
What to Expect During and After Treatment
Before the first dose, a neurosurgeon or interventional radiologist will place a tiny tube called a lumbar puncture (spinal tap) or an Ommaya reservoir (a small port implanted under the scalp). The lumbar puncture is done while you lie on your side, and a thin needle goes between the bones in your lower back to reach the CSF. The Ommaya system lets you receive multiple doses without repeated needle sticks.
During the procedure, you’ll feel a quick pinch as the needle goes in. Most people describe the sensation as a brief pressure, not unbearable pain. After the drug is injected, you’ll be asked to lie flat for about an hour. This helps the medicine spread evenly through the CSF and reduces headache risk.
Side effects can include headache, nausea, neck stiffness, or temporary nerve irritation. Serious complications like infection or bleeding are rare but possible, so it’s crucial to keep the insertion site clean and report any fever or worsening pain right away.
After each session, doctors will often check the CSF for drug levels and cancer cells. That helps them decide if the treatment is working or if adjustments are needed. Many patients notice a reduction in neurological symptoms within weeks, but full response can take several months.
Recovery at home is usually simple: stay hydrated, avoid heavy lifting for 24‑48 hours, and rest as needed. Over‑the‑counter pain relievers like acetaminophen can ease a mild headache. If you’re on blood‑thinners or have a clotting disorder, discuss special precautions with your doctor before the procedure.
In short, intrathecal chemotherapy offers a targeted way to reach cancer cells hiding in the brain or spine. It involves a short, outpatient procedure, a few manageable side effects, and close monitoring by your oncology team. Talk to your doctor about whether this option fits your diagnosis and lifestyle, and don’t hesitate to ask about the specifics of the drug, dosing schedule, and after‑care plan.
