LMD-02. Cerebrospinal Fluid Diversion for Metastatic Leptomeningeal Carcinomatosis: Palliative, Procedural and Oncologic Outcomes

Abstract

BackgroundLeptomeningeal disease (LMD) occurs in 3–5% of patients with solid metastatic tumors and often portends a severe prognosis including symptomatic hydrocephalus and intracranial hypertension. Cerebrospinal fluid (CSF) shunting can provide symptomatic relief in this patient subset; however, few studies have examined the role of shunting in the palliation, prognosis and overall oncologic care of these patients.ObjectiveTo identify and evaluate risk factors associated with prognosis after CSF diversion and assess surgical, symptomatic and oncologic outcomes in this population.MethodsA retrospective study was conducted on patients with solid-malignancy LMD treated with a shunt at an NCI-designated Comprehensive Cancer Center between 2010–2019.ResultsOne hundred and ninety patients with metastatic LMD underwent CSF diversion. Overall survival was 4.14 months from LMD diagnosis (95%CI:3.29–4.70) and 2.43 months (95%CI:2.01–3.09) from shunting. KPS at time of shunting and BrM number at LMD diagnosis demonstrated significant associations with survival (HR=0.66; 95%CI[0.51–0.86], p=0.002; HR=1.40; 95%CI[1.01–1.93] per 10 BrM, p=0.04, respectively). Eighty-three percent of patients experienced symptomatic relief, and 79% were discharged home or to rehabilitation facilities post-shunting. Post-shunt, 56% of patients received additional systemic therapy or started or completed WBRT. Complications included infection (5%), symptomatic subdural hygroma/hematoma (6.3%), and shunt externalization/removal/repair (8%). Abdominal seeding was not identified.ConclusionsCSF diversion for LMD with hydrocephalus and intracranial hypertension secondary to metastasis can achieve symptomatic relief, hospital discharge, and return to further oncologic therapy, with a complication profile unique to this pathophysiology. However, decision-making in this population must incorporate end-of-life goals of care given limited prognosis.