Kang Xun, Chen Feng, Yang Shou-Bo, Wang Ya-Li, Qian Zeng-Hui, Li Yan, Lin Hao, Li Parker, Peng Yi-Chen, Wang Xiao-Min, Li Wen-Bin
Department of Neuro-oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Department of Neurosurgery, Beijing Tiantan Hsopital, Capital Medical University, Beijing 100070, China.
World J Clin Cases. 2022 Jun 16;10(17):5595-5605. doi: 10.12998/wjcc.v10.i17.5595.
Glioblastoma (GBM) is one of the most common and aggressive primary malignant brain tumors with severe symptoms and a poor prognosis. Leptomeningeal dissemination (LMD) is a serious complication of GBM that often results in dire outcomes. There is currently no effective treatment.
To estimate the clinical outcomes of combination therapy in GBM patients with LMD.
A retrospective analysis was conducted using data collected from GBM patients diagnosed with LMD from January 2012 to December 2019 at our institution. All these patients had received at least one cycle of a combination therapy consisting of intrathecal methotrexate (MTX) and systemic chemotherapy. Clinical and pathological data were analyzed to explore the outcome of GBM patients with LMD and to determine the most effective treatment.
Twenty-six patients were enrolled in this study. The median time from GBM diagnosis to LMD development was 9.3 mo (range: 2-59 mo). The median overall survival of LMD patients from diagnosis to after receiving systemic chemotherapy in combination with intrathecal MTX was 10.5 mo (range: 2-59 mo). In the Cox univariate analysis, gross resection of tumor ( = 0.022), Karnofsky performance status (KPS) > 60 ( = 0.002), and Ommaya reservoir implant ( < 0.001) were correlated with survival. Multivariate analysis showed that KPS > 60 ( = 0.037) and Ommaya reservoir implant ( = 0.014) were positive factors correlated with survival. Myelotoxicity and gastrointestinal reactions were the common toxicities of this combination therapy. According to Common Terminology Criteria of Adverse Events 4.03, most of the patients presented with toxicity less than grade 3.
Intrathecal MTX administration combined with systemic chemotherapy is a potentially effective treatment for patients with GBM and LMD, with mild treatment-related side effects.
胶质母细胞瘤（GBM）是最常见且侵袭性最强的原发性恶性脑肿瘤之一，症状严重且预后较差。软脑膜播散（LMD）是GBM的一种严重并发症，常导致可怕的后果。目前尚无有效治疗方法。
评估联合治疗对GBM合并LMD患者的临床疗效。
对2012年1月至2019年12月在本机构诊断为LMD的GBM患者收集的数据进行回顾性分析。所有这些患者均接受了至少一个周期的由鞘内注射甲氨蝶呤（MTX）和全身化疗组成的联合治疗。分析临床和病理数据，以探讨GBM合并LMD患者的预后，并确定最有效的治疗方法。
本研究纳入了26例患者。从GBM诊断到LMD发生的中位时间为9.3个月（范围：2 - 59个月）。LMD患者从诊断到接受全身化疗联合鞘内MTX后的中位总生存期为10.5个月（范围：2 - 59个月）。在Cox单因素分析中，肿瘤全切除（P = 0.022）、卡氏功能状态（KPS）> 60（P = 0.002）和植入Ommaya储液器（P < 0.001）与生存相关。多因素分析显示，KPS > 60（P = 0.037）和植入Ommaya储液器（P = 0.014）是与生存相关的阳性因素。骨髓毒性和胃肠道反应是这种联合治疗的常见毒性反应。根据不良事件通用术语标准4.03，大多数患者出现的毒性反应低于3级。
鞘内注射MTX联合全身化疗对GBM合并LMD患者是一种潜在有效的治疗方法，且治疗相关副作用较轻。
