Palliative shunt surgery for patients with leptomeningeal metastasis

Murakami, Yuta; Ichikawa, Masahiro; Bakhit, Mudathir; Jinguji, Shinya; Sato, Taku; Fujii, Masazumi; Sakuma, Jun; Saito, Kiyoshi

doi:10.1016/j.clineuro.2018.03.008

Cited by 17 publications

(30 citation statements)

References 20 publications

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“…Current options for management of LM-associated hydrocephalus include: (1) shunt placement; (2) repeated lumbar punctures; (3) intraventricular reservoir placement; (4) endoscopic third ventriculostomy; or (5) no intervention with focus on pain management [ 3 , 4 ].…”

Section: Current Surgical Optionsmentioning

confidence: 99%

“…This greater incidence is likely due to advances in the treatment of cancer that allow patients to live long enough to develop late complications such as LM [ 1 – 3 ]. Yet, despite the progress in oncologic treatments, the prognosis for LM remains poor with average survival ranging from 3.5 to 6 months [ 1 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…LM affects approximately 5–8% of patients with solid tumors [ 5 ]. Patients with LM typically present with acute and often debilitating neurologic symptoms, including headaches, nausea, cognitive dysfunction, seizures, cranial nerve deficits, and/or weakness and pain [ 2 , 4 ]. As these symptoms greatly affect patients’ quality-of-life [ 1 ], it is of importance to effectively manage them.…”

Section: Introductionmentioning

confidence: 99%

“…As these symptoms greatly affect patients’ quality-of-life [ 1 ], it is of importance to effectively manage them. Hydrocephalus (HC) secondary to LM is common [ 6 ], though outcomes in patients with metastases-related hydrocephalus are poor with approximately 10% 1-year survival [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Management of hydrocephalus in patients with LM is challenging, as effective, immediate symptom relief often requires surgical intervention in frail cancer patients [ 4 ]. Although the available data exploring the effectiveness of ventriculoperitoneal shunt (VPS) placement in improving quality-of-life in this patient population is limited, the procedure is commonly performed to relieve patients of hydrocephalus-associated symptoms [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Management of hydrocephalus in patients with leptomeningeal metastases: an ethical approach to decision-making

et al. 2018

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PurposeLeptomeningeal metastases (LM) are a rare, but often debilitating complication of advanced cancer that can severely impact a patient’s quality-of-life. LM can result in hydrocephalus (HC) and lead to a range of neurologic sequelae, including weakness, headaches, and altered mental status. Given that patients with LM generally have quite poor prognoses, the decision of how to manage this HC remains unclear and is not only a medical, but also an ethical one.MethodsWe first provide a brief overview of management options for hydrocephalus secondary to LM. We then apply general ethical principles to decision making in LM-associated hydrocephalus that can help guide physicians and patients.ResultsManagement options for LM-associated hydrocephalus include shunt placement, repeated lumbar punctures, intraventricular reservoir placement, endoscopic third ventriculostomy, or pain management alone without intervention. While these options may offer symptomatic relief in the short-term, each is also associated with risks to the patient. Moreover, data on survival and quality-of-life following intervention is sparse. We propose that the pros and cons of each option should be evaluated not only from a clinical standpoint, but also within a larger framework that incorporates ethical principles and individual patient values.ConclusionsThe decision of how to manage LM-associated hydrocephalus is complex and requires close collaboration amongst the physician, patient, and/or patient’s family/friends/community leaders. Ultimately, the decision should be rooted in the patients’ values and should aim to optimize a patient’s quality-of-life.

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Section: Current Surgical Optionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of hydrocephalus in patients with leptomeningeal metastases: an ethical approach to decision-making

et al. 2018

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Cytologically proven leptomeningeal carcinomatosis in gastric cancer patients: Experience in a tertiary referral center

Kuo

Chang

Lin∥

et al. 2023

Adv in Digestive Medicine

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Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of advanced cancer. The reported incidence may be underestimated because of the non‐specific clinical presentation and the suboptimal accuracy of the confirmation tests. Despite advances in multidisciplinary care, the prognosis for patients with LMC remains poor. Gastric cancer (GC) ranking 9th in incidence among all kinds of malignancies in Taiwan. We aimed to review our experience with LMC in GC patients at a tertiary referral center to analyze the clinical features and survival outcomes. All patients with a malignant diagnosis of cerebrospinal fluid (CSF) cytology at the National Taiwan University Hospital were reviewed from January 2002 to December 2018. The survival analysis was calculated by the Kaplan‐Meier method. Univariate and multivariate Cox proportional hazards regression analysis were used to identify factors associated with survival. We identified 18 patients with a diagnosis of GC‐related LMC. LMC occurred in approximately 0.45% of GC patients during this period. Nine (50%) were male, and the median age was 58.5 years old. The most frequent neurological symptom of these patients was altered mental status (72.2%), followed by headache (44.4%) and nausea/vomiting (44.4%). Intracranial hypertension was noted in 87.5% with the mean opening pressure to be 385.3 mmCSF. Intrathecal (IT) chemotherapy was administered to nine patients, principally with methotrexate alone (55.6%). Fourteen patients received CSF drainage by ventriculo‐peritoneal shunt or external ventricular drainage via Ommaya reservoir for relieving intracranial hypertension. In the univariate Cox proportional hazards regression analysis, the poor ECOG performance status (>2), absence of other metastases, and absence of CSF drainage were all prognostic factors of poor survival. In conclusion, LMC was a rare manifestation of GC and was associated with an extremely poor survival when the performance status was poor at presentation. CSF drainage may have some impact on the survival duration in selected cases with LMC.

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