Outcomes of Patients with Neoplastic Meningitis Undergoing Ventriculoperitoneal Shunting and Intrathecal Chemotherapy, A Single Institution Retrospective Review
Amulya Gottiparthy1, Lauren Orda2, Emily Morrow 2, Monica Loghin2
1Houston Methodist Neurology Department, 2University of Texas MD Anderson Cancer Center Department of Neuro-Oncology
Objective:

To present the outcomes of a retrospective cohort of patients with leptomeningeal disease (LMD) who received placement of ventriculoperitoneal shunt (VPS) and Ommaya reservoir for intrathecal chemotherapy.

Background:

LMD is a devastating complication of cancer and confers a poor prognosis. Treatment modalities include radiation, intrathecal and/or systemic chemotherapy. Hydrocephalus occurs in more than half of these patients and is associated with poor prognosis.

 

Design/Methods:

We performed an in-depth chart review using electronic medical records of patients with LMD who had undergone placement of VPS and Ommaya in a single institution over a three-year period.

Results:

Eighteen patients with LMD underwent VPS placement and Ommaya reservoir for intrathecal chemotherapy. Eleven patients had breast cancer, four had lung cancer, and the remaining three patients had thyroid, esophageal and uterine cancer respectively. Seventeen patients are deceased, and one patient was lost to follow up, and not included in our analysis. Sixteen (94%) patients had brain metastases. Eleven patients (61.1%) received radiotherapy prior to VPS placement. Karnofsky scores ranged from 60 to 90. Seven (41%) patients did not receive intrathecal chemotherapy due to rapid LMD progression. Ten (59%) patients received intrathecal Topotecan, and one received Cytarabine at the time of disease progression. The overall survival of these patients from time of VPS placement was 15.15 weeks (range 4.1-203.2), of which seven (41%) survived less than eight weeks. Six (60%) patients died from LMD progression, three (30%) from systemic disease progression, and one (10%) died of medical complications.

Conclusions:

Hydrocephalus in LMD patients usually portends a rapid decline in neurologic and functional status, resulting in a poorer prognosis. Our retrospective analysis suggests urgency for early diagnosis of LMD with increased intracranial pressure, along with spinal fluid diversion procedures for intrathecal chemotherapy administration. These interventions may allow for prolongation and improvement in quality of life.

10.1212/WNL.0000000000204093