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.
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