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: | |
| Notes: | Article -- Source: Scopus |
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