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Vol.59 No.3 contents

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- Case Report -

An Elderly Case of Leptomeningeal Carcinomatosis from Non-small Cell Lung Cancer Treated Effectively with Osimertinib and Ommaya Reservoir

Manami Sazuka¹, Emiko Chikui², Hironobu Hamaya³, Chiemi Nogimori¹, Hirokazu Yamada¹, Hiroshi Yamamoto^1
1Department of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital, Japan, ²Department of Neurosurgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Japan, ³Department of Geriatric Medicine, The University of Tokyo Hospital, Japan

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Background. Leptomeningeal carcinomatosis due to non-small cell lung cancer is generally associated with a poor prognosis, and conventional therapies have little effect on improving a patient's condition. We herein report a case of leptomeningeal carcinomatosis due to metastatic non-small cell lung cancer effectively treated with osimertinib and cerebrospinal fluid drainage from the Ommaya reservoir. Case. A 78-year-old woman presented with headache, vomiting and a reduction in her cognitive function during the treatment of non-small cell lung adenocarcinoma with an EGFR mutation. She was diagnosed with leptomeningeal carcinomatosis with hydrocephalus after head computed tomography revealed enlargement of the ventricle and cerebrospinal fluid cytology showed adenocarcinoma. Osimertinib was administered as the third-line treatment, and an Ommaya reservoir was put in place for palliative cerebrospinal fluid drainage. After starting these therapies, her cognitive and physical function gradually improved, her cerebrospinal fluid cytology became negative, and we were able to control the development of leptomeningeal carcinomatosis for more than one year. Conclusion. Although leptomeningeal carcinomatosis with hydrocephalus leads to a reduction in the cognitive and physical functions and results in a poor prognosis, EGFR tyrosine kinase inhibitors and cerebrospinal fluid drainage from the Ommaya reservoir are suggested to be useful for improving the prognosis and palliation of leptomeningeal carcinomatosis.
key words: Non-small cell lung cancer, Leptomeningeal carcinomatosis, Ommaya reservoir, Epidermal growth factor receptor tyrosine kinase inhibitor, Osimertinib

Received: January 28, 2019
Accepted: April 11, 2019

JJLC 59 (3): 287-292, 2019