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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2018.00509

The comparative treatment of Intraventricular chemotherapy by Ommaya reservoir versus lumbar puncture in patients with Leptomeningeal Carcinomatosis.

 Mariano Montes de Oca Delgado1,  Bernardo Cacho Díaz2,  José Santos Zambrano1, Vicente Guerrero Juárez1, Manuel Salvador López Martínez1, Elvira Castro Martínez1, Javier Avendaño Méndez-Padilla1, Sonia Mejía Pérez1,  Ignacio Reyes Moreno3, Axayacatl Gutiérrez Aceves1 and  Alberto Gonzalez-Aguilar1, 3*
  • 1Instituto Nacional de Neurología y Neurocirugía (INNN), Mexico
  • 2Instituto Nacional de Cancerología (INCan), Mexico
  • 3Centro Médico ABC, Mexico

Object: Leptomeningeal Carcinomatosis (LCM) represents a state of systemic malignant disease with poor prognosis. The purpose of this study is to compare overall survival (OS) between intraventricular chemotherapy through Ommaya reservoir (OR) and chemotherapy through lumbar puncture (LP) in LCM. Patients & Methods: Forty adult patients with LCM were included. All patients underwent lumbar puncture and Magnetic resonance imaging (MRI). Thirty patients received chemotherapy through LP and 10 undergone colocation of Ommaya reservoir for intraventricular chemotherapy. Results: The most common symptom was headache (Present in 50%). The cranial nerves most affected were VI and VII. Leptomeningeal enhancement was the most frequent finding in MRI. The OS in the LP group was 4 months and Ommaya group was 9.2 months (p=0.0006; CI:1.8-3), with statistical differences in favor to Intraventricular treatment. Proportional hazard regression showed that receiving chemotherapy through Ommaya reservoir was a protective factor (Hazard ratio = 0.258, Standard Error = 0.112, p= 0.002 and 95% CI 0.110-0.606). Using KPS as a factor did not affect the hazard ratio of Ommaya reservoir itself. Conclusions: OS was significantly higher in patients with Ommaya reservoir in spite of Karnofsky Performance Status (KPS) previous to chemotherapy. Therefore, intraventricular chemotherapy should be preferred over lumbar puncture chemotherapy administration if there are resources available.

Keywords: Leptomenigeal carcinomatosis, chemotherapy, Overall survival (OS), Ommaya reservoir, Lumbar Puncture, Karnofsky performance scale

Received: 24 Jul 2018; Accepted: 17 Oct 2018.

Edited by:

Luis Souhami, McGill University, Canada

Reviewed by:

Maria Caffo, Università degli Studi di Messina, Italy
Yoshua Esquenazi, University of Texas Health Science Center at Houston, United States  

Copyright: © 2018 Montes de Oca Delgado, Cacho Díaz, Santos Zambrano, Guerrero Juárez, López Martínez, Castro Martínez, Avendaño Méndez-Padilla, Mejía Pérez, Reyes Moreno, Gutiérrez Aceves and Gonzalez-Aguilar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Alberto Gonzalez-Aguilar, Instituto Nacional de Neurología y Neurocirugía (INNN), Mexico City, Mexico, albertogonzalez@neurocirugia-innn.com