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Drug Delivery
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Gudrun Fleischhack, Martin Garnett, Kévin Beccaria
Intracystic therapy essentially concerns treatment of craniopharyngiomas. It is considered as an alternative to surgery and radiotherapy. The antineoplastic agent is generally injected via a subcutaneous Ommaya reservoir, whose tip is located in the tumor cyst. Before treatment, the absence of leakage outside the cyst is checked by injection of contrast agent, in order to avoid any toxicity. Bleomycin is the agent that is more currently used.
Amphotericin B Deoxycholate
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Neil R. H. Stone, Tihana Bicanic
AMB is administered in similar doses intraventricularly; the drug will distribute well into the lumbar CSF unless there is an obstruction to CSF flow. This is usually carried out using a subcutaneous Ommaya reservoir when prolonged therapy is required (Diamond and Bennett, 1973; Posner, 1973). If an Ommaya reservoir is in situ, specimens of CSF for laboratory tests should be taken by lumbar puncture, because fluid from the reservoir often shows low cell counts and normal protein and glucose values which do not reflect findings in the lumbar CSF (Goldstein et al., 1972; Holt et al., 1972).
Non-Hodgkin lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Piers Blombery, Adrian Bloor, David C. Linch
The median age of PCNSL diagnosis is approximately years; however, it does occur in younger patients where it may be associated with HIV infection. Although PCNSL is associated with a poor prognosis, an increasing evidence base is accumulating regarding its optimal treatment. In those able to tolerate it, multi-agent chemotherapy using chemotherapeutic agents able to cross the blood–brain barrier delivered in a sufficient dose and schedule to allow adequate CNS concentration for adequate anti-tumour effect is becoming established as the preferred initial treatment. Most chemotherapy regimens for PCNSL contain high-dose methotrexate (usually > 3.5g/m2) and may include other drugs such as cytarabine, ifosfamide and idarubicin.71,72 Although multi-agent chemotherapy is more effective than methotrexate alone, it is associated with more toxicity.73,74 The additive benefit of intrathecal/intraventricular chemotherapy to systemic CNS penetrating chemotherapy is unclear, with mixed results from trials to date.75 It is noteworthy that there is a significant incidence of complications associated with the Ommaya reservoir insertion that has often been used in this approach.72
Pure endoscopic resection of pineal region tumors through supracerebellar infratentorial approach with ‘head-up’ park-bench position
Published in Neurological Research, 2023
Wei Hua, Hao Xu, Xin Zhang, Guo Yu, Xiaowen Wang, Jinsen Zhang, Zhiguang Pan, Wei Zhu
The patient was a 39-year-old woman, and the chief complaint was headache and dizziness for 1 month. Her neurological examination and visual fields were normal. A preoperative MRI scan demonstrated a 1.8 × 1.8 cm short T1 signal, long T2 signal lesion located in the pineal region with heterogeneous enhancement, and hydrocephalus was also observed (Figure 2a–c). MRS showed that the highest ratio of Cho/NAA was 1.65 (Figure 2d). MRV revealed the sigmoid sinus and the basal sinus were slender on the right (Figure 2e a nd f). An Ommaya reservoir was implanted in advance because of hydrocephalus. Intraoperative frozen pathology suggested high-grade glioma. The tumor, including the part invading the third ventricle, was completely removed through a fully endoscopic SCIT approach. GTR of the pineal region tumor was confirmed by MR (Figure 2g). Final pathology confirmed glioblastoma multiforme (Figure 2h). The patient recovered well and was discharged after 9 days without any complications, and adjuvant Stupp protocol was administered.
Have treatment protocols for primary CNS lymphoma advanced in the past 10 years?
Published in Expert Review of Anticancer Therapy, 2019
Among the first chemotherapy-only protocols, the ‘Bonn protocol’ investigated a HDMTX- and cytarabine (AraC)-based systemic chemotherapy in combination with intraventricular MTX, prednisolone, and AraC in a multicenter prospective single-arm phase II trial on 65 patients (median age 62 years, range 27–75, with no low Karnofsky performance score (KPS) as an exclusion criteria) [18]. This regimen resulted in a median OS of 55 months and in an 8-year OS fraction of >50% in patients ≤60 years. A 19% rate of Ommaya reservoir infections did not result in increased permanent morbidity nor mortality; the rate of treatment-related mortality was 9%. While clinically asymptomatic leucoencephalopathy was detected on MRI in a third of patients, no signs of cognitive dysfunction were found in affected patients by extensive neuropsychometric testing at long-term follow-up [19,20].
Adult Burkitt lymphoma- an Island between lymphomas and leukemias
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
James Turro, Pratiksha Singh, Manbeer Singh Sarao, Satish Tadepalli, Pramil Cheriyath
He was transfused platelets due to his rapidly deteriorating platelet count and episodes of epistaxis, with a post-transfusion count of 29 K/uL. He was discharged after four days with a plan of outpatient chemotherapy consisting of six cycles of EPOCH (etoposide, vincristine, doxorubicin, oral prednisone and cyclophosphamide) over a period of four months. An Ommaya reservoir was placed in the right ventricle for intrathecal chemotherapy. After completion of chemotherapy, a computerized tomography chest, abdomen and pelvis confirmed remission. A month after completion of chemotherapy a magnetic resonance imaging of the brain, for acute onset facial numbness, revealed new lesions in the temporal, parietal and occipital lobes suggestive of a metastatic lymphoma. He was discharged to hospice for palliative care.