scholarly journals Surgical Treatment for Leptomeningeal Disease

2017 ◽  
Vol 24 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Andrey A. Volkov ◽  
Andreas K. Filis ◽  
Frank D. Vrionis
Keyword(s):  
Surgical Treatment ◽  
Surgical Complications ◽  
Patient Population ◽  
Leptomeningeal Carcinomatosis ◽  
Intrathecal Chemotherapy ◽  
Chemotherapeutic Agents ◽  
Treatment Modalities ◽  
Leptomeningeal Disease ◽  
Multimodal Approach ◽  
Intracerebral Pressure

Background Advancements in cancer treatment have led to more cases of leptomeningeal disease, which requires a multimodal approach. Methods Treatment modalities are reviewed from a neurosurgical standpoint, focusing on intrathecal chemotherapy and shunting devices. Potential complications and how to avoid them are discussed. Results The Ommaya reservoir and the chemoport are used for administering intrathecal chemotherapy. Use of ventriculo-lumbar perfusion can efficiently deliver chemotherapeutic agents and improve intracerebral pressure. Shunting systems, in conjunction with all of their variations, address the challenge of hydrocephalus in leptomeningeal carcinomatosis. Misplaced catheters, malfunction of the system, and shunt-related infections are known complications of treatment. Conclusions From an oncological perspective, the surgical treatment for leptomeningeal disease is limited; however, neurosurgery can be used to aid in the administration of chemotherapy and address the issue of hydrocephalus. Minimizing surgical complications is important in this sensitive patient population.

A Novel Method for Administering Intrathecal Chemotherapy in Patients With Leptomeningeal Metastases and Shunted Hydrocephalus: Case Report

2010 ◽  
Vol 67 (3) ◽  
pp. ons-ons ◽  
Author(s):  
Gabriel Zada ◽  
Thomas C. Chen
Keyword(s):  
Nuclear Imaging ◽  
Intrathecal Chemotherapy ◽  
Treatment Session ◽  
Chemotherapeutic Agents ◽  
Leptomeningeal Disease ◽  
Neoplastic Disease ◽  
Pressure Setting ◽  
Clinical Complications ◽  
Programmable Valve ◽  
Novel Method

Abstract BACKGROUND AND IMPORTANCE: Leptomeningeal metastatic disease occurs in a minority of patients with systemic neoplastic disease. Before the initiation of intrathecal chemotherapy, hydrocephalus must be addressed with a cerebrospinal fluid (CSF)-diverting shunt. CSF diversion can theoretically prematurely divert chemotherapeutic drugs that are administered intrathecally, thereby potentially reducing the efficacy of such treatments. CLINICAL PRESENTATION: We report on a patient with leptomeningeal disease and hydrocephalus secondary to metastatic bladder carcinoma requiring insertion of a programmable ventriculoperitoneal shunt and intrathecal chemotherapy. A novel method was utilized to administer intrathecal chemotherapy, in which the valve pressure setting was transiently increased during a 4-hour treatment session for intrathecal chemotherapy. No clinical complications occurred. Nuclear imaging was obtained sequentially after the injection of indium tracer into the ventricular system with the programmable valve at its baseline setting as well as at a maximal pressure setting. In the maximal valve setting condition, reduced outflow of nuclear tracer was observed at 1.5 and 4 h after injection, and normalized by 24 hours after injection. CONCLUSION: Programmable shunt valves can be utilized in a safe, controlled fashion to treat hydrocephalus associated with leptomeningeal disease, as well as regulate the outflow of CSF and minimize diversion of intrathecal chemotherapeutic agents.

scholarly journals Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Murat Gözüküçük ◽  
Esra Gülen Yıldız
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Medical Treatment ◽  
Length Of Hospital Stay ◽  
Treatment Modalities ◽  
Laboratory Findings ◽  
Factors Affecting ◽  
Laboratory Infection ◽  
Major Factors

Abstract Background This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm3, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

CTIM-02. PHASE II STUDY OF IPILIMUMAB AND NIVOLUMAB IN LEPTOMENINGEAL CARCINOMATOSIS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi49-vi49
Author(s):  
Matthew Strickland ◽  
Eudocia Quant Lee ◽  
Nancy Wang ◽  
Justine Cohen ◽  
Ugonma Chukwueke ◽  
...  
Keyword(s):  
Adverse Events ◽  
Phase Ii ◽  
Solid Tumor ◽  
Primary Tumor ◽  
Phase Ii Study ◽  
Treatment Options ◽  
Leptomeningeal Carcinomatosis ◽  
Leptomeningeal Disease ◽  
Dosing Regimens ◽  
Unacceptable Toxicity

Abstract Leptomeningeal disease (LMD) is an increasingly common complication from solid tumor malignancies with a poor prognosis and limited treatment options. We conducted a single arm Phase II study of combined ipilimumab and nivolumab in patients with LMD from solid tumor malignancies (NCT02939300). Patients received manufacturer-specific dosing regimens of combined ipilimumab and nivolumab based on primary-tumor histology until definitive progression or unacceptable toxicity. The primary end point was rate of overall survival at 3 months (OS3). A Simon two-stage design was used to compare a null hypothesis OS3 of 18% against an alternative of 44%. Eighteen patients with diverse primary tumor histologies were enrolled and all received at least one dose of combined ipilimumab and nivolumab. Median follow up based on patients still alive was 8.0 months (range: 0.5 to 15.9 months). The study met its primary endpoint as 8 of 18 (OS3 0.44; 90% CI: 0.24 to 0.66) patients were alive at three months after enrollment. One third of patients experienced one (or more) grade-3 or higher adverse events possibly related to treatment. Two patients discontinued protocol treatment due to unacceptable toxicity (hepatitis and colitis, respectively). The most frequent adverse events overall included fatigue (N=7), nausea (N=6), fever (N=6), anorexia (N=6) and rash (N=6). Combined ipilimumab and nivolumab has an acceptable safety profile and demonstrates promising activity in LMD patients; this therapeutic approach should be studied in larger, multicenter clinical trials to validate these results as well as better identify patients who will benefit.

scholarly journals Treatment modalities in primary gastric lymphoma: effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology

2014 ◽  
Vol 4 ◽  
pp. 273-278 ◽  
Author(s):  
Kucukoner Mehmet ◽  
Cihan Sener ◽  
Ummugul Uyeturk ◽  
Mesut Seker ◽  
Didem Tastekin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Medical Oncology ◽  
Gastric Lymphoma ◽  
Treatment Modalities ◽  
Primary Gastric Lymphoma

Peripherally Inserted Central Catheter Lines in the Behavioral Health Client: A Perspective

2006 ◽  
Vol 11 (3) ◽  
pp. 154-156
Author(s):  
Vera Deacon ◽  
Susan Oliver
Keyword(s):  
Behavioral Health ◽  
Chemotherapeutic Agents ◽  
Treatment Modalities ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Short Term ◽  
Hyperosmolar Solutions ◽  
Central Catheters ◽  
Indications For Use

Abstract Peripherally inserted central catheters (PICCs) are used in many different patient populations. The indications for use vary and include infusions of hyperalimentation, chemotherapeutic agents, hyperosmolar solutions, antibiotics, or long-term rehydration. However, on occasion, there are clients who do not fit the typical criteria for PICC insertion. This includes, but is not limited to, those individuals who are receiving frequent intravenous (IV) “sticks” or even short-term infusions of irritating drugs. The behavioral health client is one who may not be the typical PICC or IV patient but who may benefit from the placement of a PICC for certain treatment modalities.

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