What is Intrathecal Chemotherapy and What Should You Expect?

Reasons for Intrathecal Chemotherapy and Possible Side Effects

Anesthesiologist inject medical solution to spinal
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What is intrathecal chemotherapy, why is it used, and how is it given?

Intrathecal Chemotherapy - Definition

Intrathecal chemotherapy is a type of chemotherapy that is administered into the fluid between the membranes that line your brain and spinal cord.  The fluid that lines this space is produced in the ventricles of your brain and is called cerebrospinal fluid or CSF.  Cerebrospinal fluid serves as a buffer, protecting your brain and spinal cord during movement.

Why Do I Need Intrathecal Chemotherapy?

There are types of leukemia and lymphoma that spread to the CSF and nervous system. Unfortunately, most chemotherapy drugs are unable to reach into this area from the bloodstream.  Between the brain and the rest of the body is a layer of membranes known as the blood brain barrier.  This barrier exists to keep out toxins that could otherwise damage the brain.  Unfortunately it also keeps out many chemotherapy drugs as well.

Intrathecal chemotherapy may be used:

  • To treat cancer that has spread to the CSF
  • To prevent cancer from spreading to the CSF

Symptoms of Cancer Spread to the CSF

Symptoms that your cancer has spread to your CSF may include:

  • Headaches
  • Speech difficulties
  • Seizures
  • Changes in your vision, such as double vision
  • Thought changes

What Should I Expect?

Intrathecal chemotherapy may be given either through a spinal tap (a lumbar puncture) or through a reservoir implanted into your scalp.

Lumbar puncture - If you have a type of leukemia or lymphoma that has a tendency to spread to the nervous system, it is likely that you received a lumbar puncture, or spinal tap as part of your diagnosis. This is very similar to what you will experience while getting intrathecal chemotherapy. Your oncologist or hematologist will perform a lumbar puncture, and inject the chemotherapy directly into your CSF to kill any cancer cells.

Ommaya reservoir - If you require a number of these types of treatments, your doctor may decide to place an “Ommaya reservoir” into your scalp. This reservoir has a small catheter that reaches into the fluid around your brain. Chemotherapy drugs can be given through the Ommaya reservoir, and you will no longer need the lumbar punctures. Ommaya reservoirs are left in place throughout your treatment and are safe to go home with.

After Your Intrathecal Chemotherapy

When your injection is completed, your doctor will have you lie flat for some time in order to allow the chemotherapy to reach all areas where CSF circulates.  If you have had a lumbar puncture, you will also be kept flat on your back for awhile in order to reduce the chance of developing a spinal headache following the procedure.

When Should You Call the Doctor?

If you have received this treatment as an outpatient, you should contact your healthcare provider if you develop:

  • A fever with a temp of greater than 100F or 38C
  • Dizziness or a headache that will not go away
  • Pain in your spine
  • Numbness, tingling, or a change in sensation in your arms or legs
  • Difficulty walking

The Bottom Line

Types of leukemia and lymphoma that spread the nervous system can be difficult to treat. Cancer cells can live and multiply, possibly undetected in the CSF where traditional chemotherapy can't reach them. In order to treat and prevent this from occurring, doctors will administer intrathecal chemotherapy to kill any cancer cells.


Cheah, C., Herbert, K., O’Rourke, K. et al. A multicentre retrospective comparison of central nervous system prophylaxis strategies among patients with high-risk diffuse large B-cell lymphoma. British Journal of Cancer. 2014. 111(6):1072-9.

Ferreri, A., Bruno-Ventre, M., Donadoni, G. et al. Risk-tailored CNS prophylaxis in a mono-institutional series of 200 patients with diffuse large B-cell lymphoma treated in the rituximab era. British Journal of Haematology. 2015. 168(5):654-62.

Goodman, M. Chemotherapy: Principles of Administration. In Yarbro, C., Frogge, M., Goodman, M., Groenwald, S. eds(2000) Cancer Nursing: Principles and Practice 5th ed Jones and Bartlett: Sudbury, MA.

Norden A., Hocherg, E., and E. Hocherb. Treatment, prognosis, and prophylaxis if secondary central nervous system lymphoma. UpToDate. Updated 02/03/16. http://www.uptodate.com/contents/treatment-prognosis-and-prophylaxis-of-secondary-central-nervous-system-lymphoma

Sekiguchi, Y., Shimada, A., Imai, H. et al. Intravascular large B-cell lymphoma with pontine involvement successfully treated with R-CHOP therapy andintrathecal administration: a case report and review of literature. International Journal of Clinical and Experimental Pathology. 2014. 7(6):3363-9.

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