Department of Microbial Infections and Immunity, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Doan 1047, Columbus, OH, USA.
J Neurooncol. 2021 May;153(1):161-167. doi: 10.1007/s11060-021-03756-0. Epub 2021 Apr 15.
Leptomeningeal carcinomatosis (LMC) is a form of CNS cancer metastasis with severe morbidity. Intrathecal chemotherapy (ITC) administration through an implanted ventricular catheter reservoir (IVCR) is often utilized. Additionally, a nuclear imaging flow study can be performed prior to ITC administration to assess cerebrospinal fluid (CSF) flow. The clinical impact of a CSF flow study is unclear.
A retrospective chart review identified 31 patients with LMC that underwent IVCR placement between 2011 and 2019. Data extracted included patient demographics, nuclear imaging flow study, surgical complications, ITC toxicities and outcomes.
Potential drug-induced neurologic toxicities (headache, nausea/vomiting, altered mental status, etc.) were noted in (n = 4/16) 25% of patients who underwent a flow study prior to initiation of ITC, compared to (n = 1/15) 6.6% of patients who did not undergo a flow study. Median overall survival (OS) was 4.0 and 32.8 months for the patients that underwent a flow study versus patients who did not, respectively (p < 0.01). The mean interval from IVCR implantation to initiation of ITC was 15.2 ± 8.5 days and 3.3 ± 3.0 days in patients who underwent CSF flow study and patients that did not, respectively (p < 0.0001).
A flow study can provide information regarding CSF flow dynamics prior to initiation of ITC; however this might delay initiation of ITC which may negatively impact OS. Additionally, in our study patients that underwent a flow study had more ITC induced drug toxicity events compared to those that did not. Further studies are needed to clarify the role of CSF flow study in these patients.
脑膜癌病（LMC）是一种中枢神经系统癌症转移形式，具有严重的发病率。通过植入式脑室导管储液器（IVCR）进行鞘内化疗（ITC）是常用的治疗方法。此外，在进行 ITC 给药之前，可以进行核成像流量研究以评估脑脊液（CSF）流动。CSF 流量研究的临床影响尚不清楚。
回顾性图表审查确定了 2011 年至 2019 年间接受 IVCR 放置的 31 例 LMC 患者。提取的数据包括患者人口统计学、核成像流量研究、手术并发症、ITC 毒性和结果。
在开始 ITC 之前进行流量研究的患者中有 4/16（25%）出现潜在的药物引起的神经系统毒性（头痛、恶心/呕吐、精神状态改变等），而未进行流量研究的患者中有 1/15（6.6%）出现这种情况。进行流量研究的患者的中位总生存期（OS）为 4.0 个月，而未进行流量研究的患者为 32.8 个月（p<0.01）。进行 CSF 流量研究的患者和未进行流量研究的患者从 IVCR 植入到开始 ITC 的平均间隔分别为 15.2±8.5 天和 3.3±3.0 天（p<0.0001）。
流量研究可以在开始 ITC 之前提供 CSF 流动动力学的信息；然而，这可能会延迟 ITC 的开始，从而对 OS 产生负面影响。此外，在我们的研究中，与未进行流量研究的患者相比，进行流量研究的患者发生更多的 ITC 诱导的药物毒性事件。需要进一步的研究来阐明 CSF 流量研究在这些患者中的作用。
