Quantifying intraventricular drug delivery utilizing programmable ventriculoperitoneal shunts as the intraventricular...

Area of Science:

• Neuro-oncology
• Radiopharmaceuticals
• Medical Devices

Background:

• Programmable ventriculoperitoneal (pVP) shunts are increasingly used for intraventricular therapies like chemotherapy and radioimmunotherapy.
• Shunt adjustments optimize drug delivery to the cerebrospinal fluid (CSF) thecal space while minimizing systemic exposure.

Purpose of the Study:

• To assess the efficacy of pVP shunts as an access device for intraventricular therapies.
• To quantify intrathecal drug delivery using scintigraphy in a pVP shunt model, a method not previously reported.

Main Methods:

• Retrospective analysis of 15 patients with CNS tumors and pVP shunts (2003-2020).
• Evaluation of pVP shunt flow for compartmental radioimmunotherapy (cRIT) using In-111-DTPA scintigraphy.
• Scintigraphy at 2-4 hours and 24 hours quantified ventricular-thecal and peritoneal drug activity.

Main Results:

• 100% of 22 CSF flow studies demonstrated ventriculo-thecal drug activity.
• 73% of studies showed minimal (<12%) relative peritoneal uptake.
• No studies exhibited peritoneal uptake exceeding 37%.

Conclusions:

• All patients achieved successful drug delivery of In-111-DTPA to the ventriculo-thecal space.
• The majority of patients experienced minimal peritoneal drug uptake, suggesting targeted delivery.
• CSF flow scintigraphy effectively assesses drug distribution for intraventricular therapies.