Cerebrospinal fluid diversion for leptomeningeal metastasis: Palliative, procedural and oncologic outcomes Journal Article

   

Authors:	Bander, E. D.; Yuan, M.; Reiner, A. S.; Garton, A. L. A.; Panageas, K. S.; Brennan, C. W.; Tabar, V.; Moss, N. S.
Article Title:	Cerebrospinal fluid diversion for leptomeningeal metastasis: Palliative, procedural and oncologic outcomes
Abstract:	Background: Leptomeningeal metastasis (LM) 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. Objective: To identify and evaluate risk factors associated with prognosis after CSF diversion and assess surgical, symptomatic and oncologic outcomes in this population. Methods: A retrospective study was conducted on patients with solid-malignancy LM treated with a shunt at a NCI-designated Comprehensive Cancer Center between 2010 and 2019. Results: One hundred and ninety patients with metastatic LM underwent CSF diversion. Overall survival was 4.14 months from LM diagnosis (95% CI: 3.29–4.70) and 2.43 months (95% CI: 2.01–3.09) from shunting. Karnofsky performance status (KPS) at time of shunting and brain metastases (BrM) number at LM 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. Conclusions: CSF diversion for LM 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. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Keywords:	adult; cancer survival; treatment outcome; aged; major clinical study; overall survival; metastasis; palliative therapy; retrospective study; risk factor; health care utilization; patient care; cancer center; karnofsky performance status; cerebrospinal fluid; brain metastasis; hospital discharge; personal experience; leptomeningeal metastasis; intracranial hypertension; subdural hematoma; shunt; cancer prognosis; hygroma; human; male; female; article
Journal Title:	Journal of Neuro-Oncology
Volume:	154
Issue:	3
ISSN:	0167-594X
Publisher:	Springer
Date Published:	2021-09-01
Start Page:	301
End Page:	313
Language:	English
PMCID:	PMC8504535
DOI:	10.1007/s11060-021-03827-2
PROVIDER:	scopus
PUBMED:	34406564
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85112759895&doi=10.1007%2fs11060-021-03827-2&partnerID=40&md5=b5b8154d6e1b797ab0c90aae9713f1a4
Notes:	Article -- Source: Scopus