Sakai Mitsuaki, Ishikawa Shigemi, Ito Hiromichi, Ozawa Yuichiro, Yamamoto Tatsuo, Onizuka Masataka, Sakakibara Yuzuru
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan.
Int J Clin Oncol. 2006 Jun;11(3):243-5. doi: 10.1007/s10147-005-0558-x.
The prognosis for carcinomatous meningitis remains poor, and focal neurological dysfunctions usually do not improve despite the available treatment options. We report a case of carcinomatous meningitis from non-small-cell lung cancer treated with gefitinib, which brought about a sustained clinical response. A 40-year-old Japanese man was diagnosed with adenocarcinoma in the right lower lobe of the lung, and with multiple pulmonary and brain metastases. Six courses of carboplatin and paclitaxel chemotherapy and gamma-knife radiosurgery induced a near complete response in all lesions. However, 2 months later, cauda equina syndrome and left oculomotor paralysis from carcinomatous meningitis developed rapidly. Magnetic resonance imaging of the brain and spinal cord revealed the enhancement of leptomeningeal disseminations. The patient was treated with 250 mg/day gefitinib. All his neurological symptomatology disappeared within 2 weeks. The shrinkage of the leptomeningeal disseminations was confirmed by follow-up magnetic resonance imaging. The patient is currently doing well and is able to work. Cancer relapse was not observed at 4 months after the initiation of gefitinib. Although the survival benefit is controversial, gefitinib may have a role in the treatment of carcinomatous meningitis from non-small-cell lung cancer to improve neurological dysfunctions.
癌性脑膜炎的预后仍然很差，尽管有可用的治疗方案，但局灶性神经功能障碍通常并无改善。我们报告了一例用吉非替尼治疗的非小细胞肺癌所致癌性脑膜炎病例，该治疗带来了持续的临床缓解。一名40岁的日本男性被诊断为右下肺腺癌，并伴有多发肺和脑转移。六疗程的卡铂和紫杉醇化疗以及伽玛刀放射外科治疗使所有病灶出现近乎完全缓解。然而，2个月后，癌性脑膜炎导致的马尾综合征和左侧动眼神经麻痹迅速出现。脑和脊髓的磁共振成像显示软脑膜播散强化。该患者接受250毫克/天的吉非替尼治疗。其所有神经症状在2周内消失。随访磁共振成像证实软脑膜播散缩小。该患者目前情况良好，能够工作。开始使用吉非替尼4个月后未观察到癌症复发。尽管生存获益存在争议，但吉非替尼可能在治疗非小细胞肺癌所致癌性脑膜炎以改善神经功能障碍方面发挥作用。
