A new approach for leptomeningeal metastases: chemotherapy administered through lumbar intrathecal port.

Savas Comlek,Sezer Saglam

doi:10.1590/0004-282x-anp-2020-0554

Savas Comlek, Sezer Saglam

Open Access

https://doi.org/10.1590/0004-282x-anp-2020-0554

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Abstract

Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar puncture and Ommaya reservoir, have certain disadvantages. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients. To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases. Retrospective study of 13 patients treated with intrathecal chemotherapy for secondary leptomeningeal involvement of a primary solid tumor were included in this retrospective study. The patients received intrathecal chemotherapy through a LIP. The patients received a total of 123 intrathecal chemotherapy doses. No grade 3-4 toxicity, technical problem or severe complication developed. During a median of 136 days of follow-up (range, 67-376 days), 12 patients died (92.3%). The treatment resulted in symptom improvement in all patients and self-rated overall health and quality of life improved, compared with baseline. The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting.

Highlights

The solid tumors most commonly associated with brain metastases include melanoma, which has the highest propensity to form brain metastasis, and lung, breast, renal cell and gastrointestinal system (GIS) tumors, among which lung and breast tumors give rise to more brain metastases in total[1]
All the patients had accompanying systemic disease. These thirteen patients received a total of 123 intrathecal chemotherapy doses, and 58 cerebrospinal fluid samples were obtained for examination
In our study, encouraging results were obtained, in terms of safety, among leptomeningeal metastasis (LM) patients who received chemotherapy through a lumbar intrathecal port (LIP), at doses similar to those used with an Ommaya catheter

Summary

Introduction

The solid tumors most commonly associated with brain metastases include melanoma, which has the highest propensity to form brain metastasis, and lung, breast, renal cell and gastrointestinal system (GIS) tumors, among which lung and breast tumors give rise to more brain metastases in total[1]. Intrathecal chemotherapy is a local therapeutic modality associated with minimal systemic toxicity, allowing simultaneous administration of systemic treatment when necessary. The second technique uses an Ommaya reservoir and consists of implantation of an intraventricular catheter and subcutaneous port for the administration of intrathecal therapy[6]. Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients. Objective: To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases. Conclusions: The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting

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