scholarly journals A new approach for leptomeningeal metastases: chemotherapy administered through lumbar intrathecal port

2021 ◽  
Vol 79 (9) ◽  
pp. 816-823
Author(s):  
Savas Comlek ◽  
Sezer Saglam
Keyword(s):  
Retrospective Study ◽  
Pain Management ◽  
Technical Problem ◽  
Intrathecal Administration ◽  
Intrathecal Chemotherapy ◽  
Chemotherapeutic Agents ◽  
Leptomeningeal Metastases ◽  
Therapeutic Modality ◽  
Symptom Improvement ◽  
Safe Alternative

ABSTRACT Background: Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar puncture and Ommaya reservoir, have certain disadvantages. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients. Objective: To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases. Methods: Retrospective study of 13 patients treated with intrathecal chemotherapy for secondary leptomeningeal involvement of a primary solid tumor were included in this retrospective study. The patients received intrathecal chemotherapy through a LIP. Results: The patients received a total of 123 intrathecal chemotherapy doses. No grade 3-4 toxicity, technical problem or severe complication developed. During a median of 136 days of follow-up (range, 67-376 days), 12 patients died (92.3%). The treatment resulted in symptom improvement in all patients and self-rated overall health and quality of life improved, compared with baseline. Conclusions: The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting.

scholarly journals A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

2021 ◽  
pp. 014556132110257
Author(s):  
Dongho Shin ◽  
Andrew Ma ◽  
Yvonne Chan
Keyword(s):  
Retrospective Study ◽  
Teaching Hospital ◽  
Intraoperative Complications ◽  
Percutaneous Tracheostomy ◽  
Hospital Setting ◽  
Complication Rates ◽  
Safe Alternative ◽  
Neck Extension ◽  
Intraoperative Complication ◽  
Community Teaching

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

Pain management strategies in adults with haemophilia: a retrospective study

Haemophilia ◽  
2015 ◽  
Vol 21 (6) ◽  
pp. e487-e489
Author(s):  
X. Wang ◽  
M. Yang ◽  
S. Jackson
Keyword(s):  
Retrospective Study ◽  
Pain Management ◽  
Management Strategies ◽  
Haemophilia A

scholarly journals Management of Brain and Leptomeningeal Metastases from Breast Cancer

2020 ◽  
Vol 21 (22) ◽  
pp. 8534
Author(s):  
Alessia Pellerino ◽  
Valeria Internò ◽  
Francesca Mo ◽  
Federica Franchino ◽  
Riccardo Soffietti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Systemic Therapy ◽  
Chemotherapeutic Agents ◽  
Leptomeningeal Metastases ◽  
Targeted Agents ◽  
Molecular Subgroups ◽  
Extracranial Disease ◽  
Selection Of Patients ◽  
Selection Of

The management of breast cancer (BC) has rapidly evolved in the last 20 years. The improvement of systemic therapy allows a remarkable control of extracranial disease. However, brain (BM) and leptomeningeal metastases (LM) are frequent complications of advanced BC and represent a challenging issue for clinicians. Some prognostic scales designed for metastatic BC have been employed to select fit patients for adequate therapy and enrollment in clinical trials. Different systemic drugs, such as targeted therapies with either monoclonal antibodies or small tyrosine kinase molecules, or modified chemotherapeutic agents are under investigation. Major aims are to improve the penetration of active drugs through the blood–brain barrier (BBB) or brain–tumor barrier (BTB), and establish the best sequence and timing of radiotherapy and systemic therapy to avoid neurocognitive impairment. Moreover, pharmacologic prevention is a new concept driven by the efficacy of targeted agents on macrometastases from specific molecular subgroups. This review aims to provide an overview of the clinical and molecular factors involved in the selection of patients for local and/or systemic therapy, as well as the results of clinical trials on advanced BC. Moreover, insight on promising therapeutic options and potential directions of future therapeutic targets against BBB and microenvironment are discussed.

scholarly journals Limitations in the Design of Chimeric Antigen Receptors for Cancer Therapy

Cells ◽  
2019 ◽  
Vol 8 (5) ◽  
pp. 472 ◽  
Author(s):  
Stefan Stoiber ◽  
Bruno L. Cadilha ◽  
Mohamed-Reda Benmebarek ◽  
Stefanie Lesch ◽  
Stefan Endres ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Cancer Therapy ◽  
Rational Design ◽  
Chemotherapeutic Agents ◽  
Therapeutic Modality ◽  
T Cell Therapy ◽  
Car T Cells ◽  
Car T Cell ◽  
Car T

Cancer therapy has entered a new era, transitioning from unspecific chemotherapeutic agents to increasingly specific immune-based therapeutic strategies. Among these, chimeric antigen receptor (CAR) T cells have shown unparalleled therapeutic potential in treating refractory hematological malignancies. In contrast, solid tumors pose a much greater challenge to CAR T cell therapy, which has yet to be overcome. As this novel therapeutic modality matures, increasing effort is being invested to determine the optimal structure and properties of CARs to facilitate the transition from empirical testing to the rational design of CAR T cells. In this review, we highlight how individual CAR domains contribute to the success and failure of this promising treatment modality and provide an insight into the most notable advances in the field of CAR T cell engineering.

scholarly journals Fatal gadolinium-induced encephalopathy following accidental intrathecal administration: a case report and a comprehensive evidence-based review

2019 ◽  
Vol 44 (7) ◽  
pp. 721-729 ◽  
Author(s):  
David Anthony Provenzano ◽  
Zachary Pellis ◽  
Leonard DeRiggi
Keyword(s):  
Contrast Agents ◽  
Significant Risk ◽  
Intrathecal Administration ◽  
Evidence Based ◽  
Safe Alternative ◽  
Off Label ◽  
Safety Research ◽  
Small Doses ◽  
Fluoroscopic Imaging ◽  
Acute Neurotoxicity

Gadolinium-based contrast agents (GBCAs) have been suggested as off-label alternatives to iodine-based contrast agents for fluoroscopic imaging during interventional pain procedures. We report a case of accidental intrathecal administration of a GBCA during a neuraxial interventional pain procedure leading to acute gadolinium neurotoxicity, which resulted in encephalopathy and ultimately death. To our knowledge, it is the first published case of fatal intrathecal gadolinium-induced encephalopathy and the first published case of intrathecal gadoteridol causing serious neurologic complications. In addition, the case presented here is placed in context with an associated comprehensive, evidence-based review of the use of gadolinium in interventional pain procedures, addressing gadolinium chemistry and pharmacologic properties, neurotoxicity and radiology. Physicians must be aware that gadolinium poses a significant risk of acute neurotoxicity even in small doses. Until further safety research is performed, GBCAs should not be considered a safe alternative for use in neuraxial interventional spine procedures when there is a risk of inadvertent intrathecal administration.

Intrathecal chemotherapy with ACNU in a meningeal gliomatosis rat model

1992 ◽  
Vol 77 (5) ◽  
pp. 778-782 ◽  
Author(s):  
T. Ken Yoshida ◽  
Keiji Shimizu ◽  
Athanasios Koulousakis ◽  
volker sturm
Keyword(s):  
Survival Time ◽  
Rat Model ◽  
Intrathecal Administration ◽  
Intrathecal Chemotherapy ◽  
C6 Glioma Cells ◽  
High Dose ◽  
Tumor Inoculation ◽  
Content Type ◽  
Meningeal Gliomatosis ◽  
Rat C6 Glioma

✓ Intrathecal administration of ACNU ((1-4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride) had a remarkable chemotherapeutic effect in a rat model of meningeal gliomatosis. This effect was evaluated in rats with meningeal gliomatosis induced by an intracisternal inoculation of rat C6 glioma cells. The median survival time of the rats treated with a single dose of intrathecal ACNU (1 mg/kg) on Day 1 or Day 3 after tumor inoculation was significantly prolonged by 35.7% to 42.9% or 25.0% to 28.6%, respectively, as compared with that of the control animals. Meningeal gliomatosis rat models treated intrathecally with ACNU (1 mg/kg) 5 days after tumor inoculation or intravenously with ACNU (15 mg/kg) both failed to prolong the survival time of the animals. These findings suggest that intrathecal chemotherapy with a low dose of ACNU is effective in the early stages of meningeal gliomatosis, whereas intravenous chemotherapy with a high dose of ACNU is always ineffective.

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.

Clinical Outcome of B-Cell Chronic Lymphocytic Leukemia Following Alemtuzumab Therapy: Retrospective Study within Various Cytogenetic Risk Categories

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3164-3164
Author(s):  
Michael Fiegl ◽  
Martin Erdel ◽  
Inge Tinhofer ◽  
Georg Hopfinger ◽  
Karin Eigenberger ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Chronic Lymphocytic Leukemia ◽  
B Cell ◽  
Chemotherapeutic Agents ◽  
Lymphocytic Leukemia ◽  
Cox Regression Analysis ◽  
Trisomy 12 ◽  
11Q Deletion ◽  
Cell Chronic Lymphocytic Leukemia ◽  
13Q Deletion

Abstract B-cell chronic lymphocytic leukemia (CLL) with 17p deletion responds poorly to chemotherapeutic agents. This retrospective study evaluated the benefit of alemtuzumab monotherapy in unselected patients with advanced CLL, categorized by cytogenetic profile. Methods: This is the largest data base with efficacy analysis of alemtuzumab in CLL stratified according to cytogenetics. Detailed data analysis was done in 138 CLL patients, in whom cytogenetic analysis was performed by FISH using the standard CLL analysis categorized according to Doehner et al. (N Engl J Med343, 1910; 2000). Responses were evaluated according to the NCI criteria; progression-free survival (PFS) and overall survival (OS) were also assessed. Results: 73% of the patients were male. At start of alemtuzumab therapy, the median age was 64 years (range, 46–92); 12% were in Rai stage I, 18% in stage II, 20% in stage III, and 50% in stage IV. The median number of two prior therapies was 2 (range, 0–10); of the patients who received prior fludarabine (F) (n=113), 70% were F-refratory, 25% sensitive, and in 5% this was unknown. 30% and 17% of patients had bulky lymphadenopathy (>5 cm) and giant splenomegaly (>20 cm), respectively. Cytogenetic abnormalities were as follows: 13q deletion 14%; trisomy 12, 12%, 11q deletion 20%; 17p deletion, 33%, none of these, 22%. The overall response rate (ORR) was 38% in the total cohort. ORR was 53%, 56%, 21%, and 44% in the subgroup of 13q deletion, trisomy 12, 11q deletion, and 17p deletion, respectively; patients without any of these abnormalities had an ORR of 27%. From start of alemtuzumab, median PFS and OS for the whole cohort was 6.9 months and 30 months, respectively. Notably, PFS and OS in 17p deletion patients was 7.1 months and 19.1 months, respectively, an encouraging outcome when considering the unfavourable risk profile in these patients. In 17p deletion patients, response was remarkable also in disease involved lymph nodes (78%). Patients with F-resistant disease and 17p deletion, an extraordinarily poor prognostic group (n=25), had encouraging ORR, PFS, and OS rates (28%; 7.2 months; and 19.1 months, respectively), which did not differ from those in F-resistant patients with good risk cytogenetics. In a multivariate Cox regression analysis, independent risk factors for shorter OS were anemia (hazard ratio [HR] = 2.48; 95% CI, 1.50–4.11; P <.001), ≥3 of prior lines of therapy (HR = 2.00; 95% CI, 1.24–3.24, P =.005), and poor risk cytogenetics ([17p deletion and 11q deletion], HR = 2.23; 95% CI 1.35–3.69, P =.002). Conclusion: Alemtuzumab was effective in CLL across all cytogenetic categories evaluated. In patients with favorable cytogenetics, we observed that alemtuzumab is a highly effective therapy even when conventional chemotherapy has failed. Patients with 17p deletion achieved quite favorable ORR and OS upon alemtuzumab. Thus, the 17p deletion group can often be shifted to an “intermediate” risk CLL, and responding patients are frequently re-treated with alemtuzumab.

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