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Eltobgy M, Huntoon K, Musgrave N, et al. Impact of cerebrospinal fluid flow study in patients undergoing intrathecal chemotherapy via ventricular catheter reservoir. J Neurooncol. 2021;153(1):161-167doi: 10.1007/s11060-021-03756-0.
Eltobgy, M., Huntoon, K., Musgrave, N., Shaikhouni, A., Hardesty, D. A., Giglio, P., & Elder, J. B. (2021). Impact of cerebrospinal fluid flow study in patients undergoing intrathecal chemotherapy via ventricular catheter reservoir. Journal of neuro-oncology, 153(1), 161-167. https://doi.org/10.1007/s11060-021-03756-0
Eltobgy, Mostafa, et al. "Impact of cerebrospinal fluid flow study in patients undergoing intrathecal chemotherapy via ventricular catheter reservoir." Journal of neuro-oncology vol. 153,1 (2021): 161-167. doi: https://doi.org/10.1007/s11060-021-03756-0
Eltobgy M, Huntoon K, Musgrave N, Shaikhouni A, Hardesty DA, Giglio P, Elder JB. Impact of cerebrospinal fluid flow study in patients undergoing intrathecal chemotherapy via ventricular catheter reservoir. J Neurooncol. 2021 May;153(1):161-167. doi: 10.1007/s11060-021-03756-0. Epub 2021 Apr 15. PMID: 33860429.
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J Neurooncol. 2021 May;153(1):161-167. doi: 10.1007/s11060-021-03756-0. Epub 2021 Apr 15.

Impact of cerebrospinal fluid flow study in patients undergoing intrathecal chemotherapy via ventricular catheter reservoir.

Journal of neuro-oncology

Mostafa Eltobgy, Kristin Huntoon, Nick Musgrave, Ammar Shaikhouni, Douglas A Hardesty, Pierre Giglio, J Bradley Elder

Affiliations

  1. Department of Microbial Infections and Immunity, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  2. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, USA.
  3. College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  4. Department of Neurology, Division of Neuro-Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  5. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, USA. [email protected].

PMID: 33860429 DOI: 10.1007/s11060-021-03756-0

Abstract

PURPOSE: Leptomeningeal carcinomatosis (LMC) is a form of CNS cancer metastasis with severe morbidity. Intrathecal chemotherapy (ITC) administration through an implanted ventricular catheter reservoir (IVCR) is often utilized. Additionally, a nuclear imaging flow study can be performed prior to ITC administration to assess cerebrospinal fluid (CSF) flow. The clinical impact of a CSF flow study is unclear.

METHODS: A retrospective chart review identified 31 patients with LMC that underwent IVCR placement between 2011 and 2019. Data extracted included patient demographics, nuclear imaging flow study, surgical complications, ITC toxicities and outcomes.

RESULTS: Potential drug-induced neurologic toxicities (headache, nausea/vomiting, altered mental status, etc.) were noted in (n = 4/16) 25% of patients who underwent a flow study prior to initiation of ITC, compared to (n = 1/15) 6.6% of patients who did not undergo a flow study. Median overall survival (OS) was 4.0 and 32.8 months for the patients that underwent a flow study versus patients who did not, respectively (p < 0.01). The mean interval from IVCR implantation to initiation of ITC was 15.2 ± 8.5 days and 3.3 ± 3.0 days in patients who underwent CSF flow study and patients that did not, respectively (p < 0.0001).

CONCLUSIONS: A flow study can provide information regarding CSF flow dynamics prior to initiation of ITC; however this might delay initiation of ITC which may negatively impact OS. Additionally, in our study patients that underwent a flow study had more ITC induced drug toxicity events compared to those that did not. Further studies are needed to clarify the role of CSF flow study in these patients.

Keywords: CNS metastasis; Intrathecal chemotherapy; LMC; Leptomeningeal metastasis; Ommaya reservoir; Ventricular catheter reservoir

References

  1. Kaplan JG, DeSouza TG, Farkash A, Shafran B, Pack D, Rehman F, Fuks J, Portenoy R (1990) Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias. J Neurooncol 9:225–229 - PubMed
  2. Groves MD (2011) Leptomeningeal disease. Neurosurg Clin N Am 22(67–78):vii. https://doi.org/10.1016/j.nec.2010.08.006 - PubMed
  3. Sagar SM (1996) Neurologic complications of cancer by Jerome B. Posner, MD Philadelphia, FA Davis, 1995 482 pp, illustrated, $99.00. Ann Neurol 39:279–279. https://doi.org/10.1002/ana.410390226 - PubMed
  4. Kesari S, Batchelor TT (2003) Leptomeningeal metastases. Neurol Clin 21:25–66 - PubMed
  5. Nayar G, Ejikeme T, Chongsathidkiet P, Elsamadicy AA, Blackwell KL, Clarke JM, Lad SP, Fecci PE (2017) Leptomeningeal disease: current diagnostic and therapeutic strategies. Oncotarget 8:73312–73328. https://doi.org/10.18632/oncotarget.20272 - PubMed
  6. de Oca M, Delgado M, Cacho Díaz B, Santos Zambrano J, Guerrero Juárez V, López Martínez MS, Castro Martínez E, Avendaño Méndez-Padilla J, Mejía Pérez S, Reyes Moreno I, Gutiérrez Aceves A, González Aguilar A (2018) The comparative treatment of intraventricular chemotherapy by ommaya reservoir vs. lumbar puncture in patients with leptomeningeal carcinomatosis. Front Oncol 8:509–509. https://doi.org/10.3389/fonc.2018.00509 - PubMed
  7. Ozdemir Y, Yildirim BA, Topkan E (2016) Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors. J Neurooncol 129:329–335. https://doi.org/10.1007/s11060-016-2179-9 - PubMed
  8. Park JH, Kim YJ, Lee JO, Lee KW, Kim JH, Bang SM, Chung JH, Kim JS, Lee JS (2012) Clinical outcomes of leptomeningeal metastasis in patients with non-small cell lung cancer in the modern chemotherapy era. Lung Cancer (Amsterdam) 76:387–392. https://doi.org/10.1016/j.lungcan.2011.11.022 - PubMed
  9. Chowdhary S, Chamberlain M (2005) Leptomeningeal metastases: current concepts and management guidelines. J Natl Compr Cancer Netw 3:693–703 - PubMed
  10. Lamovec J, Zidar A (1991) Association of leptomeningeal carcinomatosis in carcinoma of the breast with infiltrating lobular carcinoma. An autopsy study. Arch Pathol Lab Med 115:507–510 - PubMed
  11. Lamovec J, Bracko M (1991) Metastatic pattern of infiltrating lobular carcinoma of the breast: an autopsy study. J Surg Oncol 48:28–33 - PubMed
  12. Altundag K, Bondy ML, Mirza NQ, Kau SW, Broglio K, Hortobagyi GN, Rivera E (2007) Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastasis. Cancer 110:2640–2647. https://doi.org/10.1002/cncr.23088 - PubMed
  13. Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM (2010) Leptomeningeal metastases in the MRI era. Neurology 74:1449–1454. https://doi.org/10.1212/WNL.0b013e3181dc1a69 - PubMed
  14. Straathof CS, de Bruin HG, Dippel DW, Vecht CJ (1999) The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis. J Neurol 246:810–814 - PubMed
  15. Wasserstrom WR, Glass JP, Posner JB (1982) Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49:759–772 - PubMed
  16. Wu YL, Zhou L, Lu Y (2016) Intrathecal chemotherapy as a treatment for leptomeningeal metastasis of non-small cell lung cancer: a pooled analysis. Oncol Lett 12:1301–1314. https://doi.org/10.3892/ol.2016.4783 - PubMed
  17. Hitchins RN, Bell DR, Woods RL, Levi JA (1987) A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis. J Clinic 5:1655–1662. https://doi.org/10.1200/jco.1987.5.10.1655 - PubMed
  18. Le Rhun E, Taillibert S, Chamberlain MC (2013) Carcinomatous meningitis: leptomeningeal metastases in solid tumors. Surg Neurol Int 4:S265-288. https://doi.org/10.4103/2152-7806.111304 - PubMed
  19. Ommaya AK (1963) Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet (London) 2:983–984. https://doi.org/10.1016/s0140-6736(63)90681-0 - PubMed
  20. Magill ST, Choy W, Nguyen MP, McDermott MW (2020) Ommaya reservoir insertion: a technical note. Cureus 12:e7731. https://doi.org/10.7759/cureus.7731 - PubMed
  21. Byrnes DM, Vargas F, Dermarkarian C, Kahn R, Kwon D, Hurley J, Schatz JH (2019) Complications of intrathecal chemotherapy in adults: single-institution experience in 109 consecutive patients. J Oncol 2019:7. https://doi.org/10.1155/2019/4047617 - PubMed
  22. Dornbos D 3rd, Elder JB, Otero JJ, Baiocchi RA, Slone HW, Puduvalli VK, Giglio P (2019) Spinal cord toxicity from intrathecal chemotherapy: a case with clinicopathologic correlation. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.05.123 - PubMed
  23. Chamberlain MC, Corey-Bloom J (1991) Leptomeningeal metastases: 111indium-DTPA CSF flow studies. Neurology 41:1765–1769 - PubMed
  24. Chamberlain MC, Kormanik PA (1996) Prognostic significance of 111indium-DTPA CSF flow studies in leptomeningeal metastases. Neurology 46:1674–1677. https://doi.org/10.1212/wnl.46.6.1674 - PubMed
  25. Chamberlain MC (1998) Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol 38:135–140. https://doi.org/10.1023/a:1005982826121 - PubMed
  26. Glantz MJ, Hall WA, Cole BF, Chozick BS, Shannon CM, Wahlberg L, Akerley W, Marin L, Choy H (1995) Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status. Cancer 75:2919–2931. https://doi.org/10.1002/1097-0142(19950615)75:12%3c2919::aid-cncr2820751220%3e3.0.co;2-9 - PubMed
  27. Leal T, Chang JE, Mehta M, Robins HI (2011) Leptomeningeal metastasis: challenges in diagnosis and treatment. Curr Cancer Ther Rev 7:319–327. https://doi.org/10.2174/157339411797642597 - PubMed
  28. Meng X, Yu J, Fan Q, Li L, Li W, Song Z, Liu X, Jiang Y, Gao M, Zhang H (2018) Characteristics and outcomes of non-Hodgkin’s lymphoma patients with leptomeningeal metastases. Int J Clin Oncol 23:783–789. https://doi.org/10.1007/s10147-018-1268-5 - PubMed
  29. Herr MM, Mohile NA, Barr PM, van Wijngaarden E, Brown EB, Rich DQ (2016) Survival of secondary central nervous system lymphoma patients in the rituximab era. Clin Lymphoma Myeloma Leuk 16:e123–e127. https://doi.org/10.1016/j.clml.2016.06.009 - PubMed

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