Mikudova V, Rejlekova K, Gyarfas J, Oravcova I, Chovanec M, Mardiak J, Mego M
Klin Onkol. 2019 Spring;32(2):139-142. doi: 10.14735/amko2018139.
Leptomeningeal metastasis (LM) in breast cancer is associated with a poor prognosis. Although no randomised trial has demonstrated that intrathecal chemotherapy actually prolongs survival, this treatment is considered standard of care in this setting. The prognosis of patients with LM is poor, with a median overall survival time of less than 6 months.
Herein, we report a case of a young woman with breast cancer who presented with LM at the time of relapse and was subsequently treated with two lines of intrathecal chemotherapy that prolonged survival.
A 28-year old woman without a significant past medical history was diagnosed with triple-negative invasive ductal carcinoma. Eight months after adjuvant treatment she developed multiple brain metastases and LM developed subsequently 1 month after finishing whole brain irradiation. Initially, she was treated with a combination of methotrexate, cytarabine and dexamethasone intrathecally but after 3 months she presented with a worsening clinical status and increased numbers of cancer cells in cerebrospinal fluid. Subsequently, she received a combination of thiotepa and methotrexate intrathecally, which resulted in a prolonged response lasting 10 months. The patient died 32 months after initial diagnosis and 18 months from LM infiltration due to disease progression in the liver and lungs as well as LM.
The prognosis of patients with LM remains poor because of the limited effectiveness of currently available therapies; however, intrathecal chemotherapy could substantially prolong survival in selected patients.
乳腺癌软脑膜转移（LM）与预后不良相关。尽管尚无随机试验证明鞘内化疗能真正延长生存期，但在这种情况下，该治疗被视为标准治疗方法。LM患者的预后较差，中位总生存时间不足6个月。
在此，我们报告一例年轻乳腺癌女性病例，该患者复发时出现LM，随后接受了两线鞘内化疗，生存期得以延长。
一名28岁既往无重大病史的女性被诊断为三阴性浸润性导管癌。辅助治疗8个月后，她出现多处脑转移，全脑放疗结束1个月后随后发生LM。最初，她接受了鞘内注射甲氨蝶呤、阿糖胞苷和地塞米松的联合治疗，但3个月后她的临床状况恶化，脑脊液中癌细胞数量增加。随后，她接受了鞘内注射噻替派和甲氨蝶呤的联合治疗，产生了持续10个月的延长反应。患者在初次诊断32个月后、LM浸润18个月后因肝脏和肺部疾病进展以及LM而死亡。
由于现有疗法效果有限，LM患者的预后仍然很差；然而，鞘内化疗可以显著延长部分患者的生存期。
