Jung Tae-Young, Chung Woong-Ki, Oh In-Jae
Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea.
Department of Radiation Oncology, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea.
Clin Neurol Neurosurg. 2014 Apr;119:80-3. doi: 10.1016/j.clineuro.2014.01.023. Epub 2014 Jan 28.
The median survival of leptomeningeal metastases is short despite therapy and is sometime associated with hydrocephalus. We investigated the prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases.
Between December 2005 and November 2012, 1343 patients had brain metastases from systemic solid tumors. Of these, 71 patients (5.3%) experienced leptomeningeal metastases from 45 lung cancers, 14 breast cancers, 4 gastric cancers and 8 other cancers. The mean age was 60 years (range 37-89). The clinical symptoms presented in the cerebral hemisphere and cerebellum in 58 patients, cranial nerve in 7 patients and spinal cord and nerves in 6 patients. Twenty-nine (40.8%) patients were Radiation Therapy Oncology Group recursive partitioning analysis (RTOG-RPA) class II and 42 (59.2%) were class III. Hydrocephalus was associated in 18 (25.4%) patients and 7 patients underwent ventriculoperioneal shunt. The primary cancer, clinical symptoms, RTOG-RPA class, surgically treated hydrocephalus and systemic chemotherapy were analyzed as the prognostic factors for overall survival.
The overall incidence of leptomeningeal seeding was 5.0% of the brain metastases. The median duration of leptomeningeal metastases from first brain metastasis was 4.0 months and 24 (33.8%) patients showed leptomeningeal metastases as the first form of brain metastasis. The median overall survival (OS) was 2.1 months. Based on the univariate and multivariate analyses, RTOG-RPA class II patients, treatment of leptomeningeal metastases (such as radiotherapy or intrathecal chemotherapy) and systemic chemotherapy improved OS with statistical significance. Surgically untreated hydrocephalus (median OS, 1.7 months) showed poor OS compared with surgically treated hydrocephalus (median OS, 5.7 months) and no hydrocephalus (median OS, 2.3 months) without statistical significance.
The leptomeningeal metastases were often associated with hydrocephalus and the surgical treatment was helpful in limited patients. The prognosis was related with RTOG-RPA class and treatment of local and systemic treatment.
尽管进行了治疗，但软脑膜转移的中位生存期较短，且有时与脑积水相关。我们研究了手术治疗脑积水在软脑膜转移中的预后意义。
2005年12月至2012年11月期间，1343例患者发生了来自全身实体瘤的脑转移。其中，71例患者（5.3%）发生了软脑膜转移，原发癌包括45例肺癌、14例乳腺癌、4例胃癌和8例其他癌症。平均年龄为60岁（范围37 - 89岁）。58例患者的临床症状出现在大脑半球和小脑，7例患者出现在脑神经，6例患者出现在脊髓和神经。29例（40.8%）患者为放射治疗肿瘤学组递归分区分析（RTOG - RPA）II级，42例（59.2%）为III级。18例（25.4%）患者合并脑积水，7例患者接受了脑室腹腔分流术。将原发癌、临床症状、RTOG - RPA分级、手术治疗的脑积水和全身化疗作为总生存期的预后因素进行分析。
软脑膜播散的总体发生率为脑转移患者的5.0%。从首次脑转移开始计算，软脑膜转移的中位持续时间为4.0个月，24例（33.8%）患者以软脑膜转移作为脑转移的首发形式。中位总生存期（OS）为2.1个月。基于单因素和多因素分析，RTOG - RPA II级患者、软脑膜转移的治疗（如放疗或鞘内化疗）和全身化疗对总生存期有统计学意义的改善。未接受手术治疗的脑积水患者（中位OS，1.7个月）与接受手术治疗的脑积水患者（中位OS，5.7个月）和无脑积水患者（中位OS，2.3个月）相比，总生存期较差，但无统计学意义。
软脑膜转移常与脑积水相关，手术治疗对部分患者有帮助。预后与RTOG - RPA分级以及局部和全身治疗有关。
