妇科癌症的中枢神经系统转移：症状管理、预后及姑息治疗策略

Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies.

作者信息

Walter Adam C, Gunderson Camille C, Vesely Sara K, Algan Ozer, Sughrue Michael, Slaughter Katrina N, Moore Kathleen N

机构信息

Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States.

出版信息

Gynecol Oncol. 2015 Mar;136(3):472-7. doi: 10.1016/j.ygyno.2014.12.020.

DOI:10.1016/j.ygyno.2014.12.020

PMID:25752572

Abstract

INTRODUCTION

CNS metastasis (CNSmet) with gynecologic malignancy (GM) is associated with poor prognosis and symptom burden. Two prognostic indices, the recursive partitioning analysis (RPA) and graded prognostic assessment (GPA), used in other solid tumors to guide intervention options were evaluated among GM patients.

METHODS

Retrospective chart review was performed to identify patients with primary GM diagnosed with CNSmet from 2005-2014. RPA and GPA were applied and evaluated for goodness of fit. Long-term survivors (LTS) were those with survival time from CNSmet ≥9 months.

RESULTS

35 patients were identified with median age of 62 years (range, 41-78). The majority had ovarian cancer (54%). Median survival was 4.5 months (0.1-25.9), and median time from initial diagnosis was 2.6 years (0-19.6). Presenting symptoms varied but headache (57%) and altered mental status (23%) were most common. 37% had a solitary CNS lesion, 31% had 2-8, and 31% >8. 57% were treated with WBRT, 14% with stereotactic radiosurgery (SRS), and 20% with combinations of treatments, and 2 elected for hospice. 27% (9/33) of the patients were LTS. The GPA was not significantly associated with patient outcome (p=0.46). The RPA predicted time to death (p=.0010).

CONCLUSION

Prognostic indices used to guide therapeutic interventions perform poorly in GM. Detection and aggressive symptom management are critical in maintaining QOL. Multidisciplinary consultation is critical to optimize outcomes and symptom control.

摘要

引言

中枢神经系统转移（CNSmet）合并妇科恶性肿瘤（GM）与预后不良及症状负担相关。本研究对GM患者评估了两种用于其他实体瘤以指导干预选择的预后指标，即递归划分分析（RPA）和分级预后评估（GPA）。

方法

进行回顾性病历审查，以确定2005年至2014年诊断为CNSmet的原发性GM患者。应用RPA和GPA并评估其拟合优度。长期生存者（LTS）是指CNSmet后生存时间≥9个月的患者。

结果

共确定35例患者，中位年龄62岁（范围41 - 78岁）。大多数为卵巢癌（54%）。中位生存期为4.5个月（0.1 - 25.9），从初始诊断到CNSmet的中位时间为2.6年（0 - 19.6）。出现的症状各异，但头痛（57%）和精神状态改变（23%）最为常见。37%有单个CNS病变，31%有2 - 8个，31%超过8个。57%接受了全脑放疗（WBRT），14%接受了立体定向放射外科治疗（SRS），20%接受了联合治疗，2例选择临终关怀。27%（9/33）的患者为长期生存者。GPA与患者预后无显著相关性（p = 0.46）。RPA可预测死亡时间（p = 0.0010）。