Le Rhun Emilie, Taillibert Sophie, Boulanger Thomas, Zairi Fahed, Bonneterre Jacques, Chamberlain Marc C
Breast Cancer Department, University Hospital - CHRU, Paris, France ; Neuro-Oncology, Department of Neurosurgery, University Hospital - CHRU, Paris, France ; Inserm U-1192, Proteomic, Inflammatory Response, Mass Spectrometry Laboratory (PRISM), Lille 1 University, Villeneuve D'Ascq, Paris, France.
Department of Neurology Mazarin, Pitié-Salpétrière Hospital, Paris, France ; Department of Radiation Oncology, Pitié-Salpétrière Hospital, Paris, France.
Case Rep Oncol. 2015 Feb 12;8(1):72-7. doi: 10.1159/000375293. eCollection 2015 Jan-Apr.
Survival of patients with leptomeningeal metastases (LM) and impaired functional status is limited to several months, and rarely does neurological function improve with treatment.
A 34-year-old female with hormone-negative and HER2-positive metastatic breast cancer was diagnosed with bulky radiographic LM 45 months after initial diagnosis. She was treated with intra-CSF trastuzumab followed by intra-CSF liposomal cytarabine; however, the cancer progressed 8 months after the diagnosis of LM. At the time of the third LM progression, the patient presented with a cauda equina syndrome and cerebellar impairment resulting in an inability to walk. She was treated with CNS-directed radiotherapy (lumbosacral and cerebellar) and bevacizumab plus vinorelbine. Rapid functional improvement occurred, and the patient regained the ability to walk and independently manage her daily activities. Twelve months later, she presented with rapid progression of the LM resulting in death within several weeks.
In radiographically defined bulky LM, the combination of systemic therapy and CNS-directed radiotherapy likely is more active than intra-CSF therapy only. In lieu of the rapid and significant improvement in neurological function combined with the prolonged response, bevacizumab alone or in combination with chemotherapy and CNS-directed radiotherapy may be considered in select patients with radiographically bulky breast cancer-related LM.
软脑膜转移（LM）且功能状态受损的患者生存期仅数月，治疗后神经功能很少改善。
一名34岁激素受体阴性、人表皮生长因子受体2（HER2）阳性的转移性乳腺癌女性患者，在初次诊断45个月后被诊断为影像学显示的大块状LM。她接受了脑脊液内注射曲妥珠单抗，随后接受脑脊液内注射脂质体阿糖胞苷治疗；然而，在LM诊断后8个月癌症进展。在第三次LM进展时，患者出现马尾神经综合征和小脑功能障碍，导致无法行走。她接受了中枢神经系统定向放疗（腰骶部和小脑）以及贝伐单抗联合长春瑞滨治疗。患者功能迅速改善，恢复了行走能力并能够独立处理日常活动。12个月后，她的LM迅速进展，数周内死亡。
在影像学定义的大块状LM中，全身治疗与中枢神经系统定向放疗联合使用可能比单纯脑脊液内治疗更有效。鉴于神经功能迅速且显著改善以及反应持续时间延长，对于影像学显示大块状乳腺癌相关LM的特定患者，可考虑单独使用贝伐单抗或联合化疗及中枢神经系统定向放疗。
