Abstract / Summary
Objective: Real-world data on Ommaya reservoir-based cerebrospinal fluid (CSF) chemotherapy for leptomeningeal metastasis (LM) in the targeted-therapy era are limited. We describe its safety and survival and explore prognostic factors in lung adenocarcinoma-associated LM. Methods: We retrospectively reviewed 68 patients with LM treated with Ommaya reservoir implantation and CSF chemotherapy. Overall survival (OS) was estimated from LM diagnosis and from implantation, and an exploratory multivariable Cox regression was performed in patients with actionable driver mutations receiving targeted therapy. Results: Device-related complications occurred in six patients (8.8%), including three catheter malpositions after freehand placement; chemotherapy-related adverse effects occurred in four (5.9%). After a median follow-up of 12.8 months, 14 patients (20.6%) had died, 10 of CNS progression. Median OS was not reached from diagnosis (24-month OS 67.8%) and 18.7 months from implantation (24-month OS 48.3%). In the exploratory analysis (n = 46), KPS, age, and EGFR mutation subtype were associated with OS from both time origins. Conclusions: Ommaya reservoir-based CSF chemotherapy was feasible with few device-related complications. Because all patients were treated and most had lung adenocarcinoma receiving targeted therapy, the favorable survival cannot be attributed to the reservoir or generalized to other primary tumors; prognostic factors require prospective validation.