Rudnicka Halina, Niwińska Anna, Gruszfeld Agnieszka, Pieńkowski Tadeusz
Kliniki Nowotworów Piersi i Chirurgii Rekonstrukcyjnej Centrum Onkologii w Warszawie.
Neurol Neurochir Pol. 2003;37(4):811-24.
Two clinical types of leptomeningeal metastases from solid tumors are observed: local and disseminated. The former (meningeal carcinomatosis) consists in nodular infiltration of leptomeninges, while the latter (carcinomatous meningitis)--in tumor cells free floating in the cerebrospinal fluid and adhering as a monolayer to the surface of neural structures. Despite the same etiology, the two types of metastasis differ in their clinical manifestation and prognosis. Meningeal carcinomatosis is more frequently diagnosed nowadays due to advances in neuroimaging techniques and the long survival of breast cancer patients. Patients with local, nodular infiltration of leptomeninges may survive many years without symptoms of the disease. On the other hand, carcinomatous meningitis, with its usually violent course and short survival, has become a major problem for oncologists and neurologists because of limited efficacy and considerable toxicity of the treatment.
The purpose of this article is to review the current knowledge about carcinomatous meningitis in breast cancer patients, taking into account pathophysiology, clinical symptoms, diagnosis, treatment and prognosis. The second aim was to present the authors' experience with the treatment of breast cancer patients suffering from carcinomatous meningitis.
37 patients with breast cancer and carcinomatous meningitis were treated in the Oncology Center, Warsaw, in the years 2000-2002. Their mean age was 51. The diagnosis was based on results of neurological examination, MRI scan, and the presence of neoplastic cells in the cerebrospinal fluid. In a majority of cases combined treatment was applied, including intrathecal administration of cytostatics, intravenous systemic chemotherapy and radiotherapy.
The observation period ranged from 2 to 33 months. A response to the treatment was achieved in 76% of the patients. Their median overall survival was 19 weeks, mean 18 weeks. Seven patients (19%) survived for over 6 months.
The ever-growing incidence of carcinomatous meningitis in the course of breast cancer has become a serious clinical problem for neurologists and oncologists. Treatment results are disappointing, although the combined modality treatment appears to be the best option. New pharmacological approaches to the treatment of meningeal malignancy are required to improve the outcome of patients with carcinomatous meningitis.
实体瘤软脑膜转移存在两种临床类型：局灶性和播散性。前者（脑膜癌病）表现为软脑膜的结节状浸润，而后者（癌性脑膜炎）则表现为肿瘤细胞在脑脊液中自由漂浮并单层附着于神经结构表面。尽管病因相同，但这两种转移类型在临床表现和预后方面存在差异。由于神经影像学技术的进步以及乳腺癌患者生存期的延长，脑膜癌病如今更常被诊断出来。软脑膜出现局灶性结节状浸润的患者可能多年无症状。另一方面，癌性脑膜炎通常病程凶险且生存期短，由于治疗效果有限且毒性较大，已成为肿瘤学家和神经学家面临的一个主要问题。
本文旨在回顾目前关于乳腺癌患者癌性脑膜炎的相关知识，涵盖病理生理学、临床症状、诊断、治疗及预后。第二个目的是介绍作者对患有癌性脑膜炎的乳腺癌患者的治疗经验。
2000年至2002年期间，华沙肿瘤中心对37例患有乳腺癌和癌性脑膜炎的患者进行了治疗。她们的平均年龄为51岁。诊断依据神经学检查结果、磁共振成像扫描以及脑脊液中肿瘤细胞的存在情况。大多数病例采用联合治疗，包括鞘内注射细胞毒性药物、静脉全身化疗和放疗。
观察期为2至33个月。76%的患者对治疗有反应。她们的中位总生存期为19周，平均为18周。7名患者（19%）存活超过6个月。
乳腺癌病程中癌性脑膜炎的发病率不断上升，已成为神经学家和肿瘤学家面临的一个严重临床问题。尽管联合治疗似乎是最佳选择，但治疗结果令人失望。需要新的药物治疗方法来改善癌性脑膜炎患者的预后。
