Dados do Resumo

Título

"GENERAL ASPECTS OF INTRATHECAL CHEMOTHERAPY USING OMMAYA RESERVOIR IN PATIENTS WITH MENINGEAL CARCINOMATOSIS."

Introdução

Intrathecal chemotherapy is a treatment in which chemotherapy drugs are administered into the cerebrospinal fluid. It is used for diseases that affect the central nervous system, such as leukemias, lymphomas, or complications like meningeal carcinomatosis, defined as the infiltration of neoplastic cells into the meninges. Intrathecal chemotherapy can be performed using an Ommaya Reservoir, where an intraventricular catheter is surgically implanted, or through a lumbar puncture.

Objetivo

The objective of this study is to analyze the general aspects of intrathecal chemotherapy via Ommaya reservoir in adult patients with neoplasms or complications affecting the central nervous system (CNS).

Métodos

For this work, a literature review was conducted in the following databases: PubMed, SciElo, Virtual Health Library (BVS), and Google Scholar. Eight scientific publications, in Portuguese and English, were analyzed, covering the period from 2006 to 2022. By inclusion criteria, five scientific works were considered that addressed the general aspects of intrathecal chemotherapy in patients who developed meningeal carcinomatosis as a complication of other neoplasms. For the exclusion criteria, three papers were chosen that did not meet the requirements. The descriptors used were: “intrathecal chemotherapy,” “ommaya reservoir,” “lumbar puncture,” “meningeal carcinomatosis,” “complications.”

Resultados

The data analysis shows that in a study evaluating patients diagnosed with meningeal carcinomatosis, the incidence of this complication ranges from 5% to 8%, compared to 5% to 15% in other hematological malignancies, highlighting its rarity. Regarding treatment, the medication used, called methotrexate, when administered via intraventricular route through the Ommaya reservoir, crosses the blood-brain barrier and has a more uniform distribution in the subarachnoid space, proving to be a better therapeutic option. On the other hand, when the same medication is administered via the lumbar route, it reduces the concentration in the cerebrospinal fluid, as it may be inadvertently injected into the subdural or epidural space. Furthermore, lumbar puncture is associated with a greater degree of pain and discomfort. The Ommaya reservoir, one of the methods for intrathecal chemotherapy via the intraventricular route, is associated with complications such as bacterial meningitis in 7.5% of cases analyzed in the study, followed by catheter obstruction in 5-9%. These data also support the method. Despite the advantages of intrathecal chemotherapy via the intraventricular route, there are no randomized studies demonstrating improved survival among patients.

Conclusões

Studies show that the best option for the treatment of neoplastic diseases that affect the CNS is intrathecal chemotherapy using an Ommaya reservoir, as through this technique it is possible for the medications to directly reach the cerebrospinal fluid, bringing greater benefits to patients, as in addition of being able to cross the blood-brain barrier, it acts directly on the liquidcerebrospinal space, providing a more uniform drug distribution throughout the subarachnoid space, in addition to causing less discomfort compared to lumbar puncture.

Palavras Chave

chemotherap carcinomatosis Ommaya