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Abstract
Object: Leptomeningeal Carcinomatosis (LCM) represents a state of systemic malignant disease with poor prognosis. The purpose of this study is to compare overall survival (OS) between intraventricular chemotherapy through Ommaya reservoir (OR) and chemotherapy through lumbar puncture (LP) in LCM.Patients and Methods: Forty adult patients with LCM were included. All patients underwent lumbar puncture and Magnetic resonance imaging (MRI). Thirty patients received chemotherapy through LP and 10 undergone colocation of Ommaya reservoir for intraventricular chemotherapy.Results: The most common symptom was headache (Present in 50%). The cranial nerves most affected were VI and VII. Leptomeningeal enhancement was the most frequent finding in MRI. The OS in the LP group was 4 months and Ommaya group was 9.2 months (p = 0.0006; CI:1.8-3), with statistical differences in favor to Intraventricular treatment. Proportional hazard regression showed that receiving chemotherapy through Ommaya reservoir was a protective factor (Hazard ratio = 0.258, Standard Error = 0.112, p = 0.002 and 95% CI 0.110-0.606). Using KPS as a factor did not affect the hazard ratio of Ommaya reservoir itself.Conclusions: OS was significantly higher in patients with Ommaya reservoir in spite of Karnofsky Performance Status (KPS) previous to chemotherapy. Therefore, intraventricular chemotherapy should be preferred over lumbar puncture chemotherapy administration if there are resources available.
Highlights
LCM is a rare complication of advanced cancer, which consists in infiltration of the meninges and Cerebrospinal fluid (CFS) space by malignant cells [1]
There is not a standard route of administration and both are recommended taking into consideration that chemotherapy needs good distribution and penetration; Intraventricular chemotherapy acts directly in CSF and probably it is superior to lumbar administration but there is not a trial that confirms this hypothesis completely
We identified 40 patients; ten patients had undergone installation of an intraventricular Ommaya reservoir (Between 2000 and 2014) and received chemotherapy for LCM while 30 patients received intrathecal chemotherapy through lumbar puncture
Summary
LCM is a rare complication of advanced cancer, which consists in infiltration of the meninges and Cerebrospinal fluid (CFS) space by malignant cells [1]. Any cancer can metastasize to meninges but is mainly detected in association with breast cancer, lung cancer, melanoma, and in fewer occasions with other types of cancer (Gastrointestinal, prostate, lymphoma, leukemia, unknown primary cancer) [2]. It has an incidence of ∼5% of the patients with cancer but because of the asymptomatic patients or late-onset symptomatology, it may increase even to 20% as biopsies studies have demonstrated [3, 4]. The median survival is around 4–6 weeks when untreated but it may improve as well as neurological status because of chemotherapy regimens [2, 4, 5]. The present article is a retrospective study that compares the Intraventricular vs. the lumbar administration of chemotherapy in LCM
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