Department of Medicine, University of Florida, Gainesville, Florida, USA
Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA.
BMJ Case Rep. 2023 Apr 18;16(4):e254027. doi: 10.1136/bcr-2022-254027.
Leptomeningeal spread of cancer is rare, difficult to both diagnostically confirm and treat, and associated with a poor prognosis. The blood-brain barrier largely prevents sufficient penetration of systemic therapy to be effective. Direct administration of intrathecal therapy has thus been used as an alternative treatment option. We present a case of breast cancer complicated by leptomeningeal spread. Intrathecal methotrexate was initiated, and the manifestation of systemic side effects suggested systemic absorption. This was subsequently confirmed by blood work showing detectable methotrexate levels following intrathecal administration as well as resolution of symptoms with reduction in the dose of methotrexate administered.
癌症的脑膜转移较为罕见，在诊断和治疗上都极具挑战性，且预后较差。血脑屏障极大地阻止了全身治疗药物的充分渗透，使其难以发挥作用。因此，人们采用鞘内治疗作为替代治疗方案。我们报告了一例乳腺癌合并脑膜转移的病例。给予患者鞘内注射甲氨蝶呤，全身不良反应的出现提示药物已被全身吸收。这随后通过血液检查得到证实，即鞘内给药后可检测到甲氨蝶呤水平，且随着甲氨蝶呤剂量的减少，症状也得到了缓解。
