Quality of life and life expectancy of leptomeningeal metastasis of breast cancer after Methotrexate chemotherapy via Ommaya: A case series

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Fitry Bhetania Jayanti Tambunan
Andre Patar Sahora Situmorang
Dewa Ayu Ina Dianata
Ralph Girson Gunarsa
Jeffry Beta Tenggara
Cosphiady Irawan
Made Agus Mahendra Inggas

Keywords

breast cancer, leptomeningeal metastases, Ommaya shunt

Abstract

Background: Metastases of breast cancer in areas of the central nervous system will have a poor prognosis. Therefore, knowledge about the management of metastases to the central nervous system, especially leptomeningeal becomes very important. This study aimed to evaluate therapy to support the evidence that intrathecal chemotherapy with Ommaya is a promising therapy for leptomeningeal metastasis of breast cancer.


Case presentation: Three cases were presented. The first case was a 49 years old female with a KPS of 80 at the beginning of methotrexate (MTX) chemotherapy via Ommaya and intravenous chemotherapy. The second case was a 54 years old female with a KPS of 90 who underwent MTX chemotherapy via Ommaya and Whole Brain Radiation Therapy. The KPS became 100. The third case was a 45 years old female with liver, lung, bone, and leptomeningeal metastatic breast cancer. Initial KPS was 70; NANO score was 2, given MTX chemotherapy via Ommaya and intravenous chemotherapy. When the general condition improved, chemotherapy via Ommaya was continued 12 times. The KPS improved to 90 and the NANO score improved to 0.


Conclusion: Intrathecal chemotherapy via Ommaya can increase the life expectancy and quality of life of breast cancer patients with leptomeningeal metastases when combined with systemic chemotherapy. The KPS before chemotherapy, patient compliance in carrying out therapy, and control of general conditions including infection status and radiation before intrathecal chemotherapy were prognostic factors that affect the success of chemotherapy via Ommaya.

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