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
Notes: Article -- Source: Scopus
Citation Impact
MSK Authors
  1. Anne S Reiner
    168 Reiner
  2. Viviane S Tabar
    170 Tabar
  3. Cameron Brennan
    192 Brennan
  4. Katherine S Panageas
    430 Panageas
  5. Evan Bander
    10 Bander
  6. Nelson Moss
    33 Moss
  7. Melissa Yuan
    4 Yuan
  8. Andrew Garton
    3 Garton