Intrathecal chemotherapy is when chemotherapy is given into the fluid around the spinal cord during a lumbar puncture.
A doctor or specially trained nurse will do the lumbar puncture. Your doctor or nurse will usually give you a local anaesthetic first. Then they will insert a hollow needle between 2 of the spinal bones in the lower back. They may take a sample of cerebrospinal fluid (CSF) for testing.
A lumbar puncture can be done in an outpatients department or on a ward at the hospital.
In some cancers, such as some types of leukaemia or lymphoma, cancer cells can pass into the CSF. Chemotherapy given into a vein or by mouth cannot easily get into the CSF. Intrathecal chemotherapy may be given if a cancer has spread to the CSF, or if there is a risk it could.
Only certain chemotherapy drugs can be given in this way. The chemotherapy drugs that are most commonly given intrathecally (with a lumbar puncture) are:
Steroids can also be given this way.
Before your treatment, your doctor will explain why you need it. You will be asked to sign a form saying that you give your permission (consent) for the hospital staff to do the lumbar puncture and give the intrathecal chemotherapy.
Specially trained staff will give the treatment in a special room of the hospital. Very rarely, you may have to travel to a different hospital if it cannot be done where you normally have your treatment.
Before you are asked to sign the consent form, you should be given full information about:
- the lumbar puncture
- what will be done
- the chemotherapy treatment
- any other tests or treatments that may be available
- any risks or side effects of the lumbar puncture and chemotherapy.
It is a good idea to have a relative or friend with you when the procedure is explained, to help you remember the discussion. You may also find it useful to write down a list of questions before you go to your appointment.
If you do not understand what you have been told, tell the staff straight away so they can explain again. Some medical treatments and procedures can be difficult to understand, so it is not unusual to need repeated explanations.
People sometimes feel that the hospital staff are too busy to answer their questions, but it is important for you to know how the intrathecal chemotherapy is likely to affect you. The staff should be willing to make time for your questions.
You will have your blood pressure and pulse checked just before the treatment. As you will need to lie flat for some time after the procedure, you may find it helpful to go to the toilet beforehand.
During your lumbar puncture, you will be asked to either:
- lie on one side with your knees pulled up towards your chest
- sit up, bending forwards over a table and supported by pillows.
These positions allow your back to curve as much as possible so that there are small spaces between the bones of your spine (vertebrae).
The doctor or nurse will clean the skin over the lower part of your back with an antiseptic solution. They will then inject a local anaesthetic to numb the area and wait a few minutes for the anaesthetic to work.
They will then insert a hollow needle between 2 of the spinal bones and into the spinal canal.
You will need to stay very still while they do this. You may feel some pressure as the needle is put in. The doctor or nurse can then withdraw samples of CSF or inject chemotherapy drugs. Or they may do both.
There are very strict guidelines for giving chemotherapy in this way. The doctor and nurses will do a number of safety checks to make sure you are only given the medicines that have been prescribed for you, and this can take time. There may be extra nurses or doctors in the room to do the safety checks. If you would like to, you can also check the drugs before they are given.
After the drug has been given, the needle is removed, and a small dressing is placed over the injection area. The whole process normally takes around 20 minutes.
If you are having intravenous chemotherapy (into a vein) on the same day, you will have this first in the ward or day unit. The intrathecal chemotherapy will only be given after the other chemotherapy has finished.
After the procedure, you will need to lie flat for a while. This may be from 1 hour to a few hours, depending on how you feel.
Having this treatment is not usually painful. Some people may find it uncomfortable or have a headache for a few hours afterwards. Tell your doctor or nurse if you have a headache, as they can give you mild painkillers to help. You will be able to move from side to side but sitting up can make a headache worse.
You will normally have your blood pressure and pulse checked again during this time. Ask the doctor or nurse when it will be safe for you to sit up.
Once you have rested and feel well, you will be able to get up and move around. But it is best not to drive or operate machinery for 24 hours after a lumbar puncture.
If you are having intrathecal chemotherapy, you may need several doses and will need to have a lumbar puncture each time.
If you have any questions about lumbar punctures or intrathecal chemotherapy, ask your doctor or nurse at the hospital where you are being treated.