Cerebrospinal fluid diversion and outcomes for lung cancer patients with leptomeningeal carcinomatosis

Yan Hua Su, Chi Lu Chiang, Huai Che Yang, Yong Sin Hu, Yu Wei Chen, Yung Hung Luo, Ching Jen Chen, Hsiu Mei Wu, Chung Jung Lin, Cheng Chia Lee*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objective: To investigate the outcomes of cerebrospinal fluid (CSF) diversion in lung cancer patients with leptomeningeal carcinomatosis (LMC). Methods: A retrospective review of consecutive lung cancer patients with LMC suffering from increased intracranial pressure (IICP) and hydrocephalus between February 2017 and February 2020. We evaluated the survival benefit of CSF diversion surgery and assessed the outcomes of treatments administered post-LMC in terms of overall survival and shunt-related complications. Results: The study cohort included 50 patients (median age: 59 years). Ventricular peritoneal (VP) shunts were placed in 33 patients, and lumbar peritoneal (LP) shunts were placed in 7 patients. Programmable shunts were placed in 36 patients. Shunt adjustment was performed in 19 patients. Kaplan-Meier analysis revealed that shunt placement increased overall survival from 1.95 months to 6.21 months (p = 0.0012) and increased Karnofsky Performance Scores (KPS) from 60 to 70. Univariate analysis revealed no difference between VP or LP shunts in terms of survival. No differences in post-shunt systemic treatments (tyrosine kinase inhibitors (TKIs) or systemic treatments) were observed in overall survival. Shunt-related complications were noted in 7 patients, including shunt obstruction (n = 4), infection (n = 1), and over-drainage (n = 2). Conclusion: CSF diversion (VP or LP shunt) appears to be an effective and safe treatment for lung cancer patients with LMC and hydrocephalus. Programmable shunts should be considered for complex cases, which commonly require pressure adjustments as the disease progresses.

Original languageEnglish
Pages (from-to)459-467
Number of pages9
JournalActa Neurochirurgica
Volume164
Issue number2
DOIs
StateE-pub ahead of print - Mar 2021

Keywords

  • Brain metastasis
  • EGFR mutation
  • Hydrocephalus
  • Leptomeningeal carcinomatosis
  • Lung cancer
  • Shunt

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