Premium
Safety profile of long‐term intraventricular access devices in pediatric patients receiving radioimmunotherapy for central nervous system malignancies
Author(s) -
Kramer Kim,
Smith Mariel,
Souweidane Mark M.
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25080
Subject(s) - medicine , ommaya reservoir , surgery , cerebrospinal fluid , catheter , radioimmunotherapy , complication , chemotherapy , monoclonal antibody , antibody , immunology
Background The use of Ommaya catheters or ventriculoperitoneal shunts with programmable valves (pVP‐shunts) for intraventricular drug administration is increasingly more common. Procedure We reviewed the safety and complication rate associated with ventricular access devices in patients receiving compartmental intraventricular radioimmunotherapy (cRIT). Results One hundred fifty one patients with recurrent primary or metastatic central nervous system (CNS) tumors (1–34 years) had a ventricular access device (143 Ommaya reservoirs, 8 VP shunts with programmable valves) placed for drug administration and cerebrospinal fluid acquisition. Patients received 2–5 serial injections 124 I‐ or 131 I‐ labeled monoclonal antibody 3F8 or 8H9. For each injection, catheters remained accessed for pharmacokinetic studies up to 48 hours or were individually accessed 3–6×/injection. Thereafter catheters were accessed for periodic routine cytology. Six patients (4%) had complications including three with catheter migration in the newly‐placed setting requiring surgical revision. Two patients had pericatheter cyst formation (with cyst formation before radioimmunotherapy administration in one patient) resulting in elective removal and endoscopic cystoventriculostomy in both patients. There were no catheter‐related infections, hemorrhages, seizures, focal deficits, or valve malfunctioning. Four patients later required Ommaya conversion to VP shunts because of hydrocephalus secondary to disease progression. Conclusions We report a long‐term safety profile of ventricular access devices in patients receiving cRIT. Minimal acute complications are observed despite the frequency of cerebrospinal fluid acquisition; long‐term complications are rare. Programmable VP shunts appear to be a safe and effective alternative to Ommaya catheters. Pediatr Blood Cancer 2014;61:1590–1592. © 2014 Wiley Periodicals, Inc.