Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
J Neurooncol. 2021 Nov;155(2):107-115. doi: 10.1007/s11060-021-03864-x. Epub 2021 Oct 8.
Glioblastoma is an aggressive cancer with a notoriously poor prognosis. Recent advances in treatment have increased overall survival, though this may be accompanied by an increased incidence of leptomeningeal disease (LMD). LMD carries a particularly severe prognosis and remains a late stage manifestation of glioblastoma without satisfactory treatment. The objective of this review is to survey the literature on treatment of LMD in glioblastoma and to more fully characterize the current therapeutic strategies.
The authors performed a systematic review following PRISMA criteria on PubMed and OVID databases. Articles that included adult patients with LMD from glioblastoma were retrieved and reviewed.
LMD in glioblastoma patients is increasing in incidence, with reports of up to 21%. The overall survival without treatment is alarmingly brief, with patients surviving between 1.6-3.8 months. All studies showed that treatment does improve overall survival significantly, increasing to 11.7 months in one study. However, no one adjuvant or surgical therapy has been shown to improve survival in LMD significantly over another. Direct treatment methods include chemotherapy (standard, anti-angiogenic, intrathecal, immunotherapy), and radiation. Hydrocephalus is a complication in LMD that can be treated with ventriculoperitoneal shunt placement, however treating hydrocephalus and delivering intrathecal chemotherapy is a challenge.
Though evidence remains lacking and there is no consensus, treatments show a trend towards improving survival and should be considered on a case-by-case basis. Further studies are necessary in the pursuit of a standard of care.
胶质母细胞瘤是一种侵袭性癌症，预后极差。最近在治疗方面的进展提高了总生存率，但这可能伴随着脑膜疾病（LMD）发病率的增加。LMD 预后特别严重，仍然是胶质母细胞瘤的晚期表现，没有令人满意的治疗方法。本综述的目的是调查胶质母细胞瘤 LMD 治疗的文献，并更全面地描述当前的治疗策略。
作者按照 PRISMA 标准对 PubMed 和 OVID 数据库进行了系统评价。检索并回顾了包括 LMD 来自胶质母细胞瘤的成年患者的文章。
胶质母细胞瘤患者的 LMD 发病率呈上升趋势，报告高达 21%。未经治疗的总生存率非常短暂，患者存活时间为 1.6-3.8 个月。所有研究均表明治疗确实显著提高了总体生存率，在一项研究中增加到 11.7 个月。然而，没有一种辅助或手术治疗方法在 LMD 中显著优于另一种方法。直接治疗方法包括化疗（标准、抗血管生成、鞘内、免疫治疗）和放疗。脑积水是 LMD 的一种并发症，可以通过脑室-腹腔分流术来治疗，但是治疗脑积水和鞘内化疗是一个挑战。
尽管证据仍然缺乏，也没有共识，但治疗方法显示出改善生存的趋势，应根据具体情况考虑。进一步的研究对于寻求护理标准是必要的。
