Eng C, Cunningham D, Quade B J, Schwamm L, Kantoff P W, Skarin A T
Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115.
Cancer. 1993 Jul 15;72(2):553-7. doi: 10.1002/1097-0142(19930715)72:2<553::aid-cncr2820720236>3.0.co;2-z.
Response rates of over 50% can be achieved in patients with metastatic transitional cell carcinoma of the bladder treated with cisplatin-based chemotherapy. With prolonged survival, intraparenchymal brain metastases may occur in as many as 12% of patients who received methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy. Meningeal carcinomatosis from urothelial cancer is rare, however. A 71-year-old man, with metastatic, transitional cell carcinoma of the bladder, attained an excellent partial response to M-VAC chemotherapy. He subsequently presented with an acute confusional state 6 months after diagnosis. Head computed tomographic studies were nondiagnostic. Gadolinium-enhanced magnetic resonance images (MRI), however, demonstrated multifocal 1-cm nodules in the brain parenchyma and enhancement of the meninges. Meningeal carcinomatosis was confirmed by lumbar puncture. Records of 40 patients with advanced transitional cell carcinoma of the bladder treated with chemotherapy between 1977 and 1992 at a cancer center were reviewed retrospectively for the occurrence of documented meningeal carcinomatosis, intraparenchymal brain metastases, or both. Among 13 responders, only 1 other patient, a 64-year-old man, was identified who had minimal metastatic disease and attained a complete response to methotrexate and cisplatin. The patient relapsed 2 years after response, with cerebellar metastases and meningeal carcinomatosis. Central nervous system (CNS) metastases in patients with transitional cell carcinoma of the bladder are unusual. Although parenchymal brain metastases may be more common after prolonged remissions induced by combination chemotherapy, meningeal carcinomatosis remains uncommon. MRI may be a useful adjunct in the diagnosis of CNS metastases. A high index of clinical suspicion for the occurrence of CNS metastases from transitional cell carcinoma is encouraged.
接受以顺铂为基础的化疗的转移性膀胱移行细胞癌患者的缓解率可超过50%。随着生存期延长，接受甲氨蝶呤、长春碱、阿霉素和顺铂（M-VAC）化疗的患者中，多达12%可能发生脑实质内脑转移。然而，尿路上皮癌引起的脑膜癌病很少见。一名71岁男性，患有转移性膀胱移行细胞癌，对M-VAC化疗获得了极佳的部分缓解。诊断后6个月，他随后出现急性意识模糊状态。头部计算机断层扫描检查未得出诊断结果。然而，钆增强磁共振成像（MRI）显示脑实质内有多个1厘米大小的结节以及脑膜强化。腰椎穿刺确诊为脑膜癌病。回顾性分析了1977年至1992年在某癌症中心接受化疗的40例晚期膀胱移行细胞癌患者的记录，以了解有记录的脑膜癌病、脑实质内脑转移或两者皆有的发生情况。在13例缓解者中，仅识别出另1例患者，为一名64岁男性，其转移病灶极少，对甲氨蝶呤和顺铂获得了完全缓解。该患者在缓解后2年复发，出现小脑转移和脑膜癌病。膀胱移行细胞癌患者发生中枢神经系统（CNS）转移并不常见。尽管联合化疗诱导长期缓解后脑实质内脑转移可能更常见，但脑膜癌病仍然不常见。MRI可能是诊断CNS转移的有用辅助手段。鼓励对膀胱移行细胞癌发生CNS转移保持高度的临床怀疑指数。
