Article
The use of programmable shunts in patients treated with tumor treating fields: Multicentric case series
Search Medline for
Authors
-
Lutz Schreiber
- Department of Neurosurgery, Sana-Kliniken, Duisburg, Deutschland
-
Marion Rapp
- Department of Neurosurgery, University Hospital, Düsseldorf, Deutschland
-
Michael Sabel
- Department of Neurosurgery, University Hospital, Düsseldorf, Deutschland
-
Julia Onken
- Department of Neurosurgery, University Hospital Charité, Berlin, Deutschland
-
Martin Misch
- Department of Neurosurgery, University Hospital Charité, Berlin, Deutschland
-
Adrian Kinzel
- Novocure GmbH, Berlin, Deutschland
-
Claudius Thomé
- Department of Neurosurgery, University Hospital, Innsbruck, Austria
-
Scholz Martin
- Department of Neurosurgery, Sana-Kliniken, Duisburg, Deutschland
-
Peter Vajkoczy
- Department of Neurosurgery, University Hospital Charité, Berlin, Deutschland
-
Christian Freyschlag
- Department of Neurosurgery, University Hospital, Innsbruck, Austria
| Published: | June 9, 2017 |
|---|
Outline
Text
Objective: Tumor Treating Fields (TTFields) are an established, non-invasive, anti-mitotic therapy for the treatment of patients with newly diagnosed or recurrent glioblastoma multiforme (GBM). TTFields are low intensity, intermediate frequency, alternating electric fields, which are delivered directly to the tumor in the brain via a System called Optune®. The Phase 3 EF-14 study demonstrated significantly prolonged overall survival in newly diagnosed GBM patients treated with TTFields + Temozolomide (TMZ) compared to TMZ alone. In addition, TTFields therapy was well tolerated without additional side effects, except of skin irritations. However, the use of a programmable shunt together with Optune still remains a contraindication.
Methods: We treated six patients (male=4, female=2) of median age 47.3 years (range 26-59 years) with newly diagnosed or recurrent GBM who had received programmable shunts due to different indications such as hydrocephalus, CSF fistula or compression of cerebral ventricles. Shunt types differ among the most commonly used types. All patients were treated with Optune together with their programmable shunt; the shunt valve was controlled at predefined time points after the initiation of Optune therapy. Additional MRI or CCT images were performed in selected cases to ensure that the shunt valve was still functioning and not negatively influenced by TTFields. Patients were treated at 4 different centers in Germany and Austria, respectively.
Results: All different programmable shunt types were functional after the simultaneous use of TTFields without any negative influence on the shunt valve setting or valve’s mechanics. Additional images in selected cases clearly showed that the shunt valve by itself worked well in the combination of both therapies.
Conclusion: This is the first multicentric case series that demonstrates the safety and feasibility of using Optune in patients with different types of programmable shunt valves. Additional studies are needed to show comparable efficacy of TTFields in patients population, as previously shown in patients without programmable shunts.
