Silvani A, Caroli M, Gaviani P, Fetoni V, Merli R, Riva M, De Rossi M, Imbesi F, Salmaggi A
Fondazione I.R.C.C.S. Istituto Neurologico C. Besta, Milano, Italy.
J Drug Deliv. 2013;2013:147325. doi: 10.1155/2013/147325. Epub 2013 Jan 16.
Neoplastic dissemination to the leptomeninges is an increasingly common occurrence in patients with both haematological and solid tumors arising outside the central nervous system. Both refinement of diagnostic techniques (Magnetic resonance imaging) and increased survival in patients treated with targeted therapies for systemic tumors account for this increased frequency. Cerebrospinal fluid cytological analysis and MRI confirm clinical diagnosis based on multifocal central nervous system signs/symptoms in a patient with known malignancy. Overall survival in patients with leptomeningeal neoplastic dissemination from solid tumors is short, rarely exceeding 3-4 months. However, selected patients may benefit from aggressive therapies, Apart from symptomatic treatment, intrathecal chemotherapy is used, with both free (methotrexate, Thiotepa, AraC) and liposomal antitumor agents (liposomal AraC). Palliative radiotherapy is indicated only in cases of symptomatic bulky disease, surgery is limited to positioning of Ommaya recervoirs or C5F shunting. We report clinical data on a cohort of 26 prospectively followed patients with neoplastic leptomeningitis followed in Lombardia, Italy, in 2011. Prognostic factors and pattern of care are reported.
肿瘤细胞播散至软脑膜在患有血液系统肿瘤和中枢神经系统以外实体瘤的患者中越来越常见。诊断技术（磁共振成像）的改进以及接受全身肿瘤靶向治疗患者生存率的提高导致了这一频率的增加。脑脊液细胞学分析和磁共振成像可根据已知恶性肿瘤患者的多灶性中枢神经系统体征/症状来确诊临床诊断。实体瘤患者发生软脑膜肿瘤播散后的总体生存期较短，很少超过3至4个月。然而，部分患者可能从积极治疗中获益。除了对症治疗外，还可使用鞘内化疗，包括游离型（甲氨蝶呤、噻替派、阿糖胞苷）和脂质体抗肿瘤药物（脂质体阿糖胞苷）。仅在出现有症状的大块病灶时才进行姑息性放疗，手术仅限于放置Ommaya贮器或C5F分流。我们报告了2011年在意大利伦巴第前瞻性随访的一组26例患有肿瘤性脑膜炎患者的临床数据。报告了预后因素和治疗模式。
