Lumboperitoneal shunt for the treatment of leptomeningeal metastasis.

Leptomeningeal metastasis (LM) is thought to be a devastating and increasingly frequent neurological complication of cancer characterized by infiltration of malignant cells into the leptomeninges and the subarachnoid space. Intracranial hypertension and hydrocephalus are observed in about half of patients with LM. They are responsible for rapidly declining neurological status and eventual poor outcome in many patients with LM. Impediment of CSF circulation is considered the pathophysiological basis of increased intracranial pressure and hydrocephalus related to LM, which makes ventriculoperitoneal shunt (VP shunt) an acceptable palliative approach for LM now. It is noteworthy that LM generally causes communicating hydrocephalus. Lumboperitoneal shunt (LP shunt) has been demonstrated to be effective in the treatment of communicating hydrocephalus secondary to hemorrhage or infection, idiopathic intracranial hypertension and normal pressure hydrocephalus. And LP shunt has several advantages over VP shunt. Therefore we hypothesize that LP shunt can be used in the treatment of intracranial hypertension and hydrocephalus related to LM and should be given greater priority over VP shunt.

[The clinical analysis of primary central nervous system lymphoma in 23 patients].

OBJECTIVE: To explore the clinical characteristics and the relationship between rational therapy and prognosis in primary central nervous system lymphoma (PCNSL). METHODS: Clinical data of 23 patients pathologically confirmed as PCNSL and treated in our hospital from January 2005 to December 2007 were collected and analyzed retrospectively. SPSS 13.0 statistical analysis software was used to analyze the correlation between therapy, clinical characteristics and prognosis. Among the 23 patient, 10 were male and 13 were female, with a median age of 50 (2 - 75) years old. Eighteen patients were undertaken lumbar puncture, and tumor cells in cerebral spinal fluid (CSF) was found in 4 patients. Tumorectomy was performed in 8 patient, while 15 patients biopsy. Among them, 4 accepted whole brain irradiation, 6 accepted associated chemotherapy based on a high-dose of methotrexate (MTX) and 13 accepted radiotherapy combined with chemotherapy. RESULTS: Kaplan-Meier analysis showed that in this serial patients, the median survival time was 45.0 months and the 3-year survival rate was 56.5%. Log-Rank test revealed that the whole survival time and the non-progression survival time of radiotherapy combined with chemotherapy (43.8 and 30.0 months, respectively) and high-dose MTX chemotherapy (39.7 and 29.7 months, respectively) were much longer than those of radiotherapy alone (25.7 and 19.8 months, respectively, all P < 0.05). Log-Rank test showed no significant difference between high-dose MTX chemotherapy alone and radiotherapy combined with chemotherapy (P > 0.05), but the whole survival time was much shorter in high-dose MTX chemotherapy (P < 0.05). CONCLUSIONS: The detection of tumor cells in CSF can confirm the diagnosis, but pathological biopsy is the gold standard. The efficacy of associated chemotherapy based on a high-dose of MTX combined with radiotherapy is much better than radiotherapy or chemotherapy alone.