Department of Neurology, Division of Neuro-oncology, Stanford Cancer Center, 875 Blake Wilbur Drive CC2221, Stanford, CA 94305, USA.
Curr Treat Options Oncol. 2012 Dec;13(4):491-504. doi: 10.1007/s11864-012-0206-4.
Leptomeningeal metastasis is a serious and frequently fatal complication of non-small cell lung cancer. Curative treatment remains elusive, but careful use of radiation, systemic chemotherapy, intrathecal chemotherapy, and symptoms management can greatly improve quality of life and survival. For most patients, we recommend a combination of skull-based radiation with focal radiation to any symptomatic spinal segments followed by systemic chemotherapy. For patients with EGFR mutations, erlotinib may be used as first-line therapy in a daily or high-dose regimen. Pemetrexed has promise for use in patients with brain and leptomeningeal metastases. Patients with multiple comorbidities or low performance status may tolerate intrathecal therapy better than systemic chemotherapy. The most commonly used intrathecal chemotherapies are methotrexate and liposomal cytarabine, although newer agents, such as topotecan and mafosfamide, may be more effective. Elevated intracranial pressure, which causes headaches, vertigo, nausea, and vomiting, should be treated with dexamethasone and acetazolamide. In select patients, cerebrospinal fluid shunting may be considered. The use of antidepressants, central nervous system stimulants, benzodiazepines, antiemetics, and pain medications can increase quality of life in patients with leptomeningeal metastases.
脑膜转移是非小细胞肺癌的一种严重且常见的致死性并发症。目前仍缺乏有效的根治方法，但仔细应用放疗、全身化疗、鞘内化疗和症状管理等方法可以明显改善生活质量并延长生存期。对于大多数患者，我们建议颅底放疗联合局部放疗（针对有症状的脊柱节段），然后进行全身化疗。对于存在 EGFR 突变的患者，厄洛替尼可作为一线治疗药物，采用每日或高剂量方案。培美曲塞在有脑转移和脑膜转移的患者中具有应用前景。存在多种合并症或体能状态较差的患者可能对鞘内治疗的耐受性更好，而非全身化疗。最常用的鞘内化疗药物是甲氨蝶呤和脂质体阿糖胞苷，尽管新的药物如拓扑替康和氨磷汀可能更有效。引起头痛、眩晕、恶心和呕吐的颅内压升高应使用地塞米松和乙酰唑胺治疗。在特定患者中，可考虑脑积水分流术。在脑膜转移患者中使用抗抑郁药、中枢神经系统兴奋剂、苯二氮䓬类、止吐药和止痛药可以提高生活质量。
