Ddel-08. the ommaya in leptomeningeal disease and central nervous system malignancies: a reservoir of the past or source of the future?

Abstract Advances in systemic therapies have increased survival in patients with metastatic cancer. However, such prolonged survival has been associated with increased incidence of leptomeningeal disease (LMD), a late-stage manifestation of cancer to the leptomeninges that carries a dismal prognosis. Circumvention of the blood-brain-barrier to treat LMD can be accomplished with intraventricular therapy using an Ommaya reservoir. Our objective is to determine the indications, efficacy, and future directions of the Ommaya reservoir in LMD and CNS malignancies. A systematic review of the literature was conducted. Data extracted from articles included year of publication, study design, cancer types, and findings. The search query returned 5,338 articles, of which 94 were included. Most articles (45, 47.9%) were prospective cohort studies. Forty-one (43.6%) described retrospective chart reviews, and five (5.3%) described RCTs. Ommaya was studied as a vehicle for intrathecal chemotherapy administration (76, 80.9%), an access site for CSF sampling (12, 12.8%), or a device through which to study dosimetry and pharmacokinetics of various drugs (5, 5.3%). Most studies (50, 53.2%) explored the use of Ommaya in LMD, secondary to any cancer (62%), breast cancer (20%), lung cancer (6%), glioma (6%), lymphoma (4%), and melanoma (2%). Sixteen articles (17%) focused on the use of Ommaya in malignant glioma, 11 studies (11.7%) in CNS lymphoma, and three (3, 3.2%) evaluated the efficacy of intraventricular morphine for intractable cancer pain. Since 2011, 24 studies (64.9%) reported positive outcomes with Ommaya, and two (5.4%) did not. The literature indicates that the Ommaya is a safe and reliable option for treatment of certain malignancies and LMD. The benefit appears to be most marked in the era of multi-modality treatment for cancer, particularly breast. Most recently, and perhaps most promising, is utilization of Ommaya for CSF analysis, both in tracking therapeutic response and defining pharmacokinetics in patients with LMD.