P16.04.B Palliative CSF diversion in symptomatic leptomeningeal metastasis: a feasibility analysis of risks and benefits

Abstract Background Leptomeningeal metastasis (LM) represents a terminal condition in subset of patients with primary extra-cranial malignancies. With improved survival rates under novel systemic therapies for tumors, the role cerebrospinal fluid (CSF) diversion via ventriculo-peritoneal shunts (VP-shunt) symptom control hydrocephalic LM is becoming increasingly important. This study hence aimed to describe this patient cohort and weigh out benefits against adverse events palliative VP-shunt placement. Material Methods A single-center retrospective analysis all consecutive adult placement over period six years was performed clinical data (primary disease, presentation, CSF diagnostics, previous therapies) addition surgical (shunt devices, surgeries, complications) were collected. Results compared ‘non-oncological’ shunt statistical analyses performed. 38 median age 53 (18-78) (13 males, 25 females) underwent VP-Shunt The most common underlying oncological conditions breast cancer (n=21, 55%) non-small cell lung (NSCLC, n=11, 29%). time between tumor diagnosis 23 months (0 180 months). 14 (37%) presented end-stage disease at diagnosis, (66%) had cranial metastases. Most classical symptoms intracranial hypertension 11 (38%) already received intrathecal treatment or radiotherapy before shunting. After shunting, relief achieved 30 (79%) 24 (63%) eventually discharged home after surgery. Subsequently, 63% shunted 55% therapy. Revision surgery valve malfunctions infections (n=3, 8% either) distal catheter malposition (n=2, 5%) but comparison showed no differences complication rates. Median from shunting 2.1 (95% CI 0.5 3 Conclusion could relieve secondary solid tumors without higher risk complications non-oncological patients, many persuing further oncologic However, decision-making regarding still retains nature.