Department of Neurology and Neurological Surgery, Division of Neuro-Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1023, USA.
Semin Neurol. 2010 Jul;30(3):236-44. doi: 10.1055/s-0030-1255220. Epub 2010 Jun 24.
Leptomeningeal metastasis occurs in ~5% of all patients with cancer and is the third most common metastatic complication of the central nervous system. Staging of leptomeningeal metastasis includes contrast-enhanced brain and spine magnetic resonance imaging and radionuclide cerebrospinal fluid (CSF) flow study. Treatment, when clinically indicated, often requires administration of involved-field radiotherapy to bulky or symptomatic disease sites as well as intra-CSF and systemic chemotherapy. The use of high-dose systemic therapy may benefit selected patients with breast- or lymphoma-related leptomeningeal metastasis and obviate the need for intra-CSF chemotherapy. Intra-CSF drug therapy primarily utilizes one of three chemotherapeutic agents (e.g., methotrexate, cytosine arabinoside, and thiotepa) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Beginning to be utilized are novel intra-CSF agents, such as the targeted monoclonal antibodies rituximab (anti-CD20 for B-cell lymphoma-related leptomeningeal metastasis) and trastuzumab (anti-Her2/neu for breast cancer-related leptomeningeal metastasis). Although treatment of leptomeningeal metastasis is palliative with median patient survival of 2 to 3 months, treatment may afford stabilization and protection from further neurologic deterioration in patients with leptomeningeal metastasis.
脑膜转移发生在约 5%的所有癌症患者中，是中枢神经系统第三大常见转移并发症。脑膜转移的分期包括增强对比脑和脊柱磁共振成像以及放射性核素脑脊髓液 (CSF) 流动研究。当临床需要时，治疗通常需要对体积较大或有症状的疾病部位进行受累野放疗，以及脑室内和全身化疗。高剂量全身治疗可使某些乳腺癌或淋巴瘤相关脑膜转移患者受益，并避免需要脑室内化疗。脑室内药物治疗主要使用三种化疗药物之一（例如甲氨蝶呤、阿糖胞苷和噻替派），通过各种方案通过椎管内或脑室药物递送进行给药。新型脑室内药物，如靶向单克隆抗体利妥昔单抗（用于 B 细胞淋巴瘤相关脑膜转移的抗 CD20）和曲妥珠单抗（用于乳腺癌相关脑膜转移的抗 Her2/neu），开始被应用。尽管脑膜转移的治疗是姑息性的，中位患者生存时间为 2 至 3 个月，但治疗可能使脑膜转移患者稳定，并防止进一步的神经恶化。
