Background

Leptomeningeal metastasis (LM) occurs in 3–5% of patients with solid metastatic tumors and often portends a severe prognosis including symptomatic hydrocephalus and intracranial hypertension. Cerebrospinal fluid (CSF) shunting can provide symptomatic relief in this patient subset; however, few studies have examined the role of shunting in the palliation, prognosis and overall oncologic care of these patients.

Objective

To identify and evaluate risk factors associated with prognosis after CSF diversion and assess surgical, symptomatic and oncologic outcomes in this population.

Methods

A retrospective study was conducted on patients with solid-malignancy LM treated with a shunt at a NCI-designated Comprehensive Cancer Center between 2010 and 2019.

Results

One hundred and ninety patients with metastatic LM underwent CSF diversion. Overall survival was 4.14 months from LM diagnosis (95% CI: 3.29–4.70) and 2.43 months (95% CI: 2.01–3.09) from shunting. Karnofsky performance status (KPS) at time of shunting and brain metastases (BrM) number at LM diagnosis demonstrated significant associations with survival (HR = 0.66; 95% CI [0.51–0.86], p = 0.002; HR = 1.40; 95% CI [1.01–1.93] per 10 BrM, p = 0.04, respectively). Eighty-three percent of patients experienced symptomatic relief, and 79% were discharged home or to rehabilitation facilities post-shunting. Post-shunt, 56% of patients received additional systemic therapy or started or completed WBRT. Complications included infection (5%), symptomatic subdural hygroma/hematoma (6.3%), and shunt externalization/removal/repair (8%). Abdominal seeding was not identified.

Conclusions

CSF diversion for LM with hydrocephalus and intracranial hypertension secondary to metastasis can achieve symptomatic relief, hospital discharge, and return to further oncologic therapy, with a complication profile unique to this pathophysiology. However, decision-making in this population must incorporate end-of-life goals of care given limited prognosis.

中文翻译：

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脑脊液分流治疗软脑膜转移：姑息性、程序性和肿瘤学结果

背景

软脑膜转移 (LM) 发生在 3-5% 的实体转移性肿瘤患者中，通常预示着严重的预后，包括症状性脑积水和颅内高压。脑脊液 (CSF) 分流可以缓解该患者亚组的症状；然而，很少有研究检查分流在这些患者的缓解、预后和整体肿瘤治疗中的作用。

客观的

识别和评估与脑脊液转移后预后相关的风险因素，并评估该人群的手术、症状和肿瘤学结果。

方法

对 2010 年至 2019 年间在 NCI 指定的综合癌症中心接受分流治疗的实体恶性肿瘤 LM 患者进行了一项回顾性研究。

结果

190 名转移性 LM 患者接受了脑脊液转移。LM 诊断后的总生存期为 4.14 个月（95% CI：3.29-4.70），分流后的总生存期为 2.43 个月（95% CI：2.01-3.09）。分流时的卡诺夫斯基体能状态 (KPS) 和 LM 诊断时的脑转移 (BrM) 数量与生存率显着相关（HR = 0.66；95% CI [0.51–0.86]，p = 0.002；HR = 1.40；95% CI [1.01–1.93] 每 10 BrM，p = 0.04，分别）。83% 的患者症状缓解，79% 的患者在分流后出院回家或前往康复机构。分流后，56% 的患者接受了额外的全身治疗或开始或完成了 WBRT。并发症包括感染 (5%)、有症状的硬膜下水瘤/血肿 (6.3%) 和分流外置/移除/修复 (8%)。

结论

脑积水和继发于转移的颅内高压的 LM 脑脊液分流可以实现症状缓解、出院并返回进一步的肿瘤治疗，这种病理生理学具有独特的并发症特征。然而，鉴于预后有限，该人群的决策必须纳入临终关怀目标。