Safety profile of long-term intraventricular access devices in pediatric patients receiving radioimmunotherapy for central nervous system malignancies Journal Article

  

Authors:	Kramer, K.; Smith, M.; Souweidane, M. M.
Article Title:	Safety profile of long-term intraventricular access devices in pediatric patients receiving radioimmunotherapy for central nervous system malignancies
Abstract:	Background: The use of Ommaya catheters or ventriculoperitoneal shunts with programmable valves (pVP-shunts) for intraventricular drug administration is increasingly more common. Procedure: We reviewed the safety and complication rate associated with ventricular access devices in patients receiving compartmental intraventricular radioimmunotherapy (cRIT). Results: One hundred fifty one patients with recurrent primary or metastatic central nervous system (CNS) tumors (1-34 years) had a ventricular access device (143 Ommaya reservoirs, 8 VP shunts with programmable valves) placed for drug administration and cerebrospinal fluid acquisition. Patients received 2-5 serial injections 124I- or 131I- labeled monoclonal antibody 3F8 or 8H9. For each injection, catheters remained accessed for pharmacokinetic studies up to 48hours or were individually accessed 3-6×/injection. Thereafter catheters were accessed for periodic routine cytology. Six patients (4%) had complications including three with catheter migration in the newly-placed setting requiring surgical revision. Two patients had pericatheter cyst formation (with cyst formation before radioimmunotherapy administration in one patient) resulting in elective removal and endoscopic cystoventriculostomy in both patients. There were no catheter-related infections, hemorrhages, seizures, focal deficits, or valve malfunctioning. Four patients later required Ommaya conversion to VP shunts because of hydrocephalus secondary to disease progression. Conclusions: We report a long-term safety profile of ventricular access devices in patients receiving cRIT. Minimal acute complications are observed despite the frequency of cerebrospinal fluid acquisition; long-term complications are rare. Programmable VP shunts appear to be a safe and effective alternative to Ommaya catheters. © 2014 Wiley Periodicals, Inc.
Keywords:	radioimmunotherapy; cns metastases; ommaya; intraventricular access devices
Journal Title:	Pediatric Blood and Cancer
Volume:	61
Issue:	9
ISSN:	1545-5009
Publisher:	Wiley Periodicals, Inc
Date Published:	2014-09-01
Start Page:	1590
End Page:	1592
Language:	English
DOI:	10.1002/pbc.25080
PROVIDER:	scopus
PUBMED:	24777835
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84904433637&partnerID=40&md5=f07d6103a384148332becf557362180e
Notes:	Export Date: 1 August 2014 -- CODEN: PBCEA -- Source: Scopus

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