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  • Survival Following Ommaya Placement for Neoplastic Meningitis: A Multicenter Retrospective Study

    Final Number:
    1476

    Authors:
    Marie Roguski MD; Chih-Ta Lin MD; Deborah Cushing RN; Jeffrey Florman MD; Julian K. Wu MD; Anand Indulal Rughani MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Neoplastic meningitis (NM) is a devastating late manifestation of cancer. NM is associated with a dismal prognosis with most patients succumbing within a few months. Given the poor prognosis associated with NM, identifying appropriate patients for Ommaya reservoir placement is difficult. We were interested in evaluating the outcomes of patients with NM treated with Ommaya reservoir placement in order to determine whether any patient factors were associated with early mortality or late survival.

    Methods: A retrospective chart review of 80 patients treated with Ommaya reservoir placement at 3 medical centers from September 2001 through September 2012 was performed. Information regarding patient characteristics and dates of diagnosis, procedure, and death were collected. The primary outcome was death. Differences in survival, as measured by time from Ommaya reservoir placement to death or last follow-up, were assessed with Kaplan-Meier survival analysis using SAS 9.2 (Cary, NC). Logistic regression modeling was performed in order to identify factors associated with survival.

    Results: Tumor types included solid organ, hematologic, and central nervous system primary in 53.8%, 41.3%, and 5%, respectively (table 1). Median overall survival was 72.5 days (95% CI 36.0-122.0) with 30% expiring within 30 days and only 13.8% surviving more than one year (table 2, figure 1). There were no differences in median overall survival between sites (p=0.366) despite differences between time from NM diagnosis to Ommaya reservoir placement being noted (p=0.025) (table 3, 4; figure 2). Median overall survival was 111.0 days and 51.0 days for patients with hematologic and solid tumor malignancies, respectively (p=0.335, figure 3). Diagnosis of hematologic cancer was inversely associated with death within 90 days (p=0.044, OR 0.366); increasing age was associated with death within 90 days (p=0.052, OR 1.043 per yearly increase in age)(figure 4).

    Conclusions: The prognosis of NM remains poor despite treatment with intraventricular chemotherapy.

    Patient Care: Patients with neoplastic meningitis have an extremely poor prognosis. This research may help guide clinical decisions regarding which patients are appropriate for Ommaya reservoir placement.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of recognizing leptomeningeal carcinomatosis in patients with malignancies, 2) Discuss, in small groups, factors that help determine prognosis and suitability for Ommaya reservoir placement, and 3) Identify which patients would most likely benefit from Ommaya reservoir placement.

    References: 1. Beauchesne P: Intrathecal chemotherapy for treatment of leptomeningeal dissemination of metastatic tumours. Lancet Oncol 11:871-79, 2010 2. Chamberlain MC, Kormanik PA, Barba D: Complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases. J Neurosurg 87:694-699, 1997 3. Grimm S, Chamberlain M: Leptomeningeal metastases, in Packer RJ (ed): Neuro-oncology. West Sussex: Wiley-Blackwell 2012, pp 200-212 4. Gwak H, Lee C, Yang HS, Joo J, Shin SH, Yoo H, et al: Chemoport with a non-collapsible chamber as a replacement for an Ommaya reservoir in the treatment of leptomeningeal carcinomatosis. Acta Neurochir 153:1971-1978, 2011 5. Jayson GC, Howel A, Harris M, Morgenstern G, Chang J, Ryder WD: Carcinomatous meningitis in patients with breast cancer: an aggressive disease varient. Cancer 74:3135-41, 1994 6. Sandberg DI, Bilsky MH, Souweidane MM, Bzdil J, Gutin P: Ommaya Reservoirs for the Treatment of Leptomeningeal Metastases. Neurosurgery 47(1):49-55, 2000 7. Sculier JP: Treatment of leptomeningeal carcinomatosis. Cancer Treatment Reviews 12:95-104, 1985 8. Yoshida S, Morii K: Intrathecal chemotherapy for patients with meningeal carcinomatosis. Surgical Neurology 63:52-55, 2005 9. Zairi F, Rhun EL, Tetard MC, Kotecki N, Assaker R: Complications related to placement of an intraventricular chemotherapy device. J Neurooncol 104:247-252, 2011

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