Croisile B, Trillet-Lenoir V, Catajar J F, Coto C, Aimard G, Trillet M, Brune J
Service de Neurologie, Hôpital Neurologique, Lyon.
Rev Neurol (Paris). 1992;148(6-7):488-92.
We report the cases of 37 patients with carcinoma of the lung revealed by brain metastases. The most frequent clinical manifestation was focal neurological symptoms associated with headache and vomiting in 50% of the cases. X-ray films of the chest were abnormal in 34 patients. At the time of diagnosis 11 patients also presented with extra-cerebral metastases. The histological type of the primary lung tumor was obtained by examination of the thorax in 32 cases and in 5 cases from brain or lymph node metastases: 11 patients had small-cell lung carcinoma and 26 had non small-cell lung carcinoma. The overall actuarial median survival was 4.5 months, irrespective of the histological type. The group of 20 patients who underwent neurosurgery had a longer median survival (10 months versus 4.5, p < 0.05), and in the subgroup where brain and lung resections were combined the median survival was even longer (13 months). Cerebral relapses occurred in 12 patients: in 7 out of 15 patients with brain surgery but without adjuvant brain radiotherapy, and in 5 out of 16 patients with brain radiotherapy without neurosurgery. No cerebral relapse was observed in the group of 5 patients who had complete resection followed by radiotherapy of the brain. This demonstrated a clear benefit from postoperative radiotherapy. Conventional chemotherapy induced objective responses only in the small-cell carcinoma group and could be too toxic when combined with simultaneous radiotherapy, but it proved a useful adjuvant treatment in patients with radiotherapy of the brain.
我们报告了37例因脑转移而发现的肺癌患者的病例。最常见的临床表现是局灶性神经症状，伴有头痛和呕吐，50%的病例出现此症状。34例患者的胸部X线片异常。诊断时，11例患者还伴有脑外转移。通过对32例患者的胸部检查以及5例患者的脑或淋巴结转移灶检查，获得了原发性肺肿瘤的组织学类型：11例患者为小细胞肺癌，26例为非小细胞肺癌。总体精算中位生存期为4.5个月，与组织学类型无关。接受神经外科手术的20例患者的中位生存期较长（10个月对4.5个月，p<0.05），在脑和肺联合切除的亚组中，中位生存期更长（13个月）。12例患者发生脑复发：15例接受脑手术但未进行辅助脑放疗的患者中有7例，16例接受脑放疗但未进行神经外科手术的患者中有5例。在5例进行了全切除并随后进行脑放疗的患者组中未观察到脑复发。这表明术后放疗有明显益处。传统化疗仅在小细胞癌组中诱导了客观反应，与同步放疗联合时可能毒性过大，但在接受脑放疗的患者中，它被证明是一种有用的辅助治疗方法。
