Le Rhun Emilie, Taillibert Sophie, Chamberlain Marc C
Division of Neuro-Oncology in the Department of Neurosurgery, University Hospital and the Breast Unit in the Department of Medical Oncology, Oscar Lambret Center, Lille Cedex, France.
Division of Neuro-Oncology in the Departments of Neurology, and Radiation Oncology, Pitie-Salpetriere Hospital, and Assistance Publique des Hopitaux de Paris, Universite Pierre et Marie Curie, Paris, France.
Cancer Control. 2017 Jan;24(1):22-32. doi: 10.1177/107327481702400104.
Neoplastic meningitis, a central nervous system (CNS) complication of cancer metastatic to the meninges and cerebrospinal fluid (CSF), is relevant to oncologists due to the impact of the disease on patient quality of life and survival rates.
A review of the literature of articles published in English was conducted with regard to neoplastic meningitis.
The incidence of neoplastic meningitis is increasing because patients with cancer are surviving longer in part because of the use of novel therapies with poor CNS penetration. Up to 5% of patients with solid tumors develop neoplastic meningitis during the disease course (breast cancer, lung cancer, and melanoma being the predominantly causative cancers). The rate of median survival in patients with untreated neoplastic meningitis is 1 to 2 months, although it can be as long as 5 months in some cases. Therapeutic options for the treatment of neoplastic meningitis include systemic therapy (cancer-specific, CNS-penetrating chemotherapy or targeted therapies), intra-CSF administration of chemotherapy (methotrexate, cytarabine, thiotepa) and CNS site-specific radiotherapy. Determining whom to treat with neoplastic meningitis remains challenging and, in part, relates to the extent of systemic disease, the neurological burden of disease, the available systemic therapies, and estimated rates of survival.
The prognosis of neoplastic meningitis remains poor. The increasing use of novel, targeted therapies and immunotherapy in solid tumors and its impact on neoplastic meningitis remains to be determined and is an area of active research. Thus, well conducted trials are needed.
肿瘤性脑膜炎是癌症转移至脑膜和脑脊液（CSF）引起的中枢神经系统（CNS）并发症，由于该疾病对患者生活质量和生存率的影响，肿瘤学家对此予以关注。
对以英文发表的关于肿瘤性脑膜炎的文献进行综述。
肿瘤性脑膜炎的发病率正在上升，这是因为癌症患者的生存期延长，部分原因是使用了中枢神经系统穿透性差的新型疗法。高达5%的实体瘤患者在病程中会发生肿瘤性脑膜炎（乳腺癌、肺癌和黑色素瘤是主要的致病癌症）。未经治疗的肿瘤性脑膜炎患者的中位生存期为1至2个月，不过在某些情况下可长达5个月。治疗肿瘤性脑膜炎的选择包括全身治疗（癌症特异性、中枢神经系统穿透性化疗或靶向治疗）、脑脊液内化疗（甲氨蝶呤、阿糖胞苷、塞替派）和中枢神经系统部位特异性放疗。确定哪些肿瘤性脑膜炎患者需要治疗仍然具有挑战性，部分原因与全身疾病的程度、疾病的神经负担、可用的全身治疗方法以及估计的生存率有关。
肿瘤性脑膜炎的预后仍然很差。实体瘤中新型靶向治疗和免疫治疗的使用增加及其对肿瘤性脑膜炎的影响仍有待确定，这是一个活跃的研究领域。因此，需要开展精心设计的试验。
