Maillie L, Salgado L R, Lazarev S
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Radiation Oncology, Elmhurst Hospital, New York, NY, USA.
Clin Transl Oncol. 2021 Oct;23(10):2109-2119. doi: 10.1007/s12094-021-02615-8. Epub 2021 Apr 21.
Leptomeningeal disease (LMD) is a rare but deadly complication of cancer in which the disease spreads to the cerebrospinal fluid and seeds the meninges of the central nervous system (CNS). Craniospinal irradiation (CSI) involves treatment of the entire CNS subarachnoid space and is occasionally used as a last-resort palliative therapy for LMD.
This review examined literature describing the role of CSI for LMD from solid and hematologic malignancies in adults. A search for studies published until September 1, 2020 was conducted using PubMed database.
A total of 262 unique articles were identified. Thirteen studies were included for analysis in which a total of 275 patients were treated with CSI for LMD. Median age at time of irradiation was 43 years, and most patients had KPS score of 70 and higher. The most common cancers resulting in LMD were acute lymphocytic leukemia, breast cancer, and acute myelogenous leukemia. Median CSI dose was 30 Gy and 18% of patients were treated with proton radiation. 52% of patients had stable-to-improved neurologic symptoms. Median overall survival for the entire cohort was 5.3 months. Patients treated with marrow-sparing proton radiation had median OS of 8 months. The most common treatment toxicities were hematologic and gastrointestinal events.
Despite advances in systemic and radiation therapies, LMD remains a devastating end-stage complication of some malignancies. Treatment-related toxicities can be a significant barrier to CSI delivery. In select patients with LMD, marrow-sparing proton CSI may provide safer palliation of symptoms and prolong survival.
软脑膜疾病(LMD)是一种罕见但致命的癌症并发症,疾病扩散至脑脊液并累及中枢神经系统(CNS)的脑膜。全脑全脊髓照射(CSI)涉及对整个CNS蛛网膜下腔进行治疗,偶尔用作LMD的最后姑息治疗手段。
本综述研究了描述CSI对成人实体瘤和血液系统恶性肿瘤所致LMD作用的文献。使用PubMed数据库检索截至2020年9月1日发表的研究。
共识别出262篇独特文章。纳入13项研究进行分析,其中共有275例患者接受CSI治疗LMD。照射时的中位年龄为43岁,大多数患者的KPS评分≥70。导致LMD最常见的癌症是急性淋巴细胞白血病、乳腺癌和急性髓细胞白血病。CSI的中位剂量为30 Gy,18%的患者接受质子放疗。52%的患者神经症状稳定或改善。整个队列的中位总生存期为5.3个月。接受骨髓保护质子放疗的患者中位总生存期为8个月。最常见的治疗毒性是血液学和胃肠道事件。
尽管全身治疗和放疗取得了进展,但LMD仍然是某些恶性肿瘤毁灭性的终末期并发症。与治疗相关的毒性可能是实施CSI的重大障碍。在部分LMD患者中,骨髓保护质子CSI可能提供更安全的症状缓解并延长生存期。