COMPLICATIONS ASSOCIATED WITH INTRAVENTRICULAR CHEMOTHERAPY IN PATIENTS WITH LEPTOMENINGEAL METASTASES

The authors studied complications associated with intraventricular che motherapy in patients with leptomeningeal metastases (LM). One hundred twenty consecutive patients with LM (71 females and 49 males) ranging in age from 10 to 72 years (median 42 years) were treated with involv ed-field radiotherapy and intraventricular chemotherapy using an Ommay a reservoir and intraventricular catheter system. The diagnosis of LM was determined by a combination of clinical presentation (114 patients ); cerebrospinal fluid cytological studies (100); or neuroradiographic studies (42). Systemic tumor histological findings included breast (3 4 patients); non-Hodgkin's lymphoma (22); melanoma (16); primitive neu roectodermal tumors including medulloblastoma (10); glial neoplasms, l eukemia, small cell lung, nonsmall cell lung, and colon (six each); pr ostate and kidney (three each); and gastric cancers (two). Sixteen pat ients, all with non-Hodgkin's lymphoma, also had acquired immune defic iency syndrome. Patients received one to four (median two) chemotherap eutic drugs and underwent a total of 1110 cycles of intraventricular c hemotherapy (median 10). Intraventricular chemotherapy administration and diagnostic Ommaya reservoir punctures totaled 4400, with a median of 46 per patient. Complications included aseptic/chemical meningitis (52 patients); myelosuppression due to intraventricular chemotherapy ( 21); catheter-related infections (nine); unidirectional catheter obstr uction (six); intraventricular catheter malpositioning (two); Ommaya r eservoir exposure (two); leukoencephalopathy (two); and chemotherapy-r elated myelopathy (one). There were no treatment-related deaths; howev er, seven patients (6%) required additional surgery for either cathete r repositioning (two) or reservoir removal (five). Seven patients with catheter-related infections were treated successfully with intraventr icular and systemic antibiotic drugs, thereby preserving the Ommaya sy stem. The authors conclude that Ommaya reservoirs are convenient and p harmacologically rational systems for administering intraventricular c hemotherapy. Overall, serious complications requiring surgery are infr equent (6%) and most often secondary to catheter infections, Ommaya re servoir exposure, or initial catheter malpositioning. Tn the majority of instances, catheter infections may be managed medically, as may the most common complications of intraventricular chemotherapy including aseptic meningitis (43% of patients) and myelosuppression (18%).