Palliative cerebrospinal fluid shunting for leptomeningeal metastasis-related hydrocephalus in patients with lung adenocarcinoma: A single-center retrospective study.

Koichi Mitsuya,Yoko Nakasu,Hideyuki Harada,Tateaki Naito,Kazushige Wakuda,Akira Ono,Haruyasu Murakami,Shoichi Deguchi,Toshiaki Takahashi,Nakamasa Hayashi,Hirotsugu Kenmotsu,Apar Kishor Ganti

doi:10.1371/journal.pone.0210074

Abstract

PurposeManagement of leptomeningeal metastasis-related hydrocephalus (LM-H) is particularly challenging regarding the control of severe headache, nausea, and vomiting due to intracranial hypertension. To investigate the improvements of performance status and outcome with cerebrospinal fluid (CSF) shunt surgery for LM-H in patients with lung adenocarcinoma.MethodsData on patients with leptomeningeal metastasis-related hydrocephalus from lung adenocarcinoma diagnosed by MR imaging and/or cytological examination were retrospectively analyzed. Between August 2008 and July 2017, the authors reviewed 31 patients requiring CSF shunt, who underwent ventriculo-peritoneal or lumbo-peritoneal shunt.ResultsThe patients consisted of 11 men and 20 women with a median age of 59 years. Twenty-six patients received EGFR-tyrosine kinase inhibitors (TKIs). CSF shunt surgery yielded rapid improvement in the performance status of 90.3% of patients. Median overall survival from the diagnosis of LM in patients with ECOG performance status less than 2 was 7.7 months, and this was significantly longer than those in patients with PS 3 or 4 (4.4 or 1.5 months; p<0.001). Multivariate analysis by Cox regression revealed survival differences according to PS at diagnosis of LM [PS 1–3 vs. PS4, hazard ratio (HR) 0.201, p = 0.034], controlled extracranial disease (HR 0.248, p = 0.005), and post-shunt EGFR-TKI for LM treatment (HR 0.193, p = 0.008). Postoperative symptomatic peritoneal carcinomatosis was observed in one patient (3.2%).ConclusionCSF shunting may be a safe and effective strategy in patients with LM-H from lung adenocarcinoma. A prospective study is needed to establish the effectiveness and safety of palliative CSF shunt for LM-H.

Highlights

Leptomeningeal metastasis (LM) is a devastating complication of cancer that affects 5% to 8% of all patients with solid tumors [1]
Multivariate analysis by Cox regression revealed survival differences according to performance status (PS) at diagnosis of LM [PS 1–3 vs. PS4, hazard ratio (HR) 0.201, p = 0.034], controlled extracranial disease (HR 0.248, p = 0.005), and post-shunt EGFR-tyrosine kinase inhibitors (TKIs) for LM treatment (HR 0.193, p = 0.008)
We investigated the outcomes of cerebrospinal fluid (CSF) shunting and concomitant multimodal therapy for LM with hydrocephalus (LM-H) from lung adenocarcinoma in our institution

Summary

Introduction

Leptomeningeal metastasis (LM) is a devastating complication of cancer that affects 5% to 8% of all patients with solid tumors [1]. The median survival time of untreated patients with LM is only 4 to 6 weeks, but survival can be extended to 4 to 6 months by treatment in selected patients [2, 3]. As described previously [4], the treatment of LM usually includes intrathecal chemotherapy, systemic therapy, radiotherapy, and surgery. Systemic chemotherapy is a main option to treat systemic disease, but data on its effect for patients with LM are lacking. A few recent case series on epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) use for patients with LM have been reported, these studies included only a small number of patients [4, 9, 10]

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Conclusion