Leptomeningeal carcinomatosis complications [Neurosurgery Wiki]

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====== Leptomeningeal carcinomatosis complications ======

[[Hydrocephalus]] occurs in a significant proportion of [[patient]]s, is associated with poor [[prognosis]] and reduced [[quality of life]], and usually precludes the use of intrathecal therapy.

Misplaced catheters, malfunction of the system, and [[shunt]]-related infections are known complications of treatment.
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Data on patients with [[leptomeningeal]] [[metastasis]]-related [[hydrocephalus]] from lung [[adenocarcinoma]] diagnosed by [[MR imaging]] and/or [[cytology]] were retrospectively analyzed by Mitsuya et al., from the [[Shizuoka Cancer Center]]. Between August 2008 and July 2017, the authors reviewed 31 patients requiring CSF shunt, who underwent [[ventriculoperitoneal shunt]] or [[lumboperitoneal shunt]].

The patients consisted of 11 men and 20 women with a median age of 59 years. Twenty-six patients received [[EGFR]]-[[tyrosine kinase inhibitor]]s (TKIs). [[CSF]] [[shunt]] surgery yielded rapid improvement in the [[performance]] status of 90.3% of patients. [[Median overall survival]] from the diagnosis of Leptomeningeal carcinomatosis in patients with [[ECOG performance status]] less than 2 was 7.7 months, and this was significantly longer than those in patients with PS 3 or 4 (4.4 or 1.5 months; p<0.001). [[Multivariate]] analysis by [[Cox regression]] revealed survival differences according to PS at diagnosis of LC [PS 1-3 vs. PS4, [[hazard ratio]] (HR) 0.201, p = 0.034], controlled [[extracranial metastases]] (HR 0.248, p = 0.005), and post-shunt EGFR-TKI for LC treatment (HR 0.193, p = 0.008). Postoperative symptomatic [[peritoneal carcinomatosis]] was observed in one patient (3.2%).

CSF shunting may be a safe and effective strategy in patients with LC-H from lung adenocarcinoma. A prospective study is needed to establish the effectiveness and safety of palliative CSF shunt for LM-H
((Mitsuya K, Nakasu Y, Hayashi N, Deguchi S, Takahashi T, Murakami H, Naito T,
Kenmotsu H, Ono A, Wakuda K, Harada H. Palliative cerebrospinal fluid shunting
for leptomeningeal metastasis-related hydrocephalus in patients with lung
adenocarcinoma: A single-center retrospective study. PLoS One. 2019 Jan
10;14(1):e0210074. doi: 10.1371/journal.pone.0210074. eCollection 2019. PubMed
PMID: 30629621.
)).