Intrathecal chemotherapy

A lumbar puncture can be done in an outpatients department or on a ward at the hospital.

A doctor or specialist nurse will do the lumbar puncture. Your doctor or nurse will usually give you a local anaesthetic in your lower back first. Then they will insert a needle between 2 of the spinal bones. The doctor or nurse then takes a sample of cerebrospinal fluid (CSF) for testing.

In some cancers, such as some leukaemias or lymphomas, the 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:

• methotrexate
• cytarabine.

Steroids can also be given this way.

A nurse or doctor will check your blood pressure and pulse before the treatment. You will need to lie flat for some time after the procedure, so you might want to go to the toilet first.

During your lumbar puncture, you will 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 the back with an antiseptic solution. They will then inject a local anaesthetic to numb the area. This may take a few minutes to work.

They will then insert a 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 will:

• take a sample of CSF
• inject chemotherapy drugs
• do both.

There are very strict guidelines for giving chemotherapy in this way. The doctor and nurses will do a number of safety checks. This is to make sure you are only given the medicines that have been prescribed for you. 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 doctor or nurse will remove the needle and place a small dressing 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 it first in the ward or day unit. The intrathecal chemotherapy will only be given after the other chemotherapy has finished.

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