Chamberlain M C
Department of Neurosciences, University of California, San Diego, USA.
J Child Neurol. 1997 Jan;12(1):53-9. doi: 10.1177/088307389701200109.
Fifteen children ranging in age from 4 to 18 years with leptomeningeal metastases were evaluated for extent of tumor and treated with radiotherapy or chemotherapy. Histologic diagnosis included: acute lymphoblastic leukemia (4); anaplastic astrocytoma (1); ependymoma (2); nonseminomatous germ cell tumor (1); non-Hodgkin's lymphoma (1); pineoblastoma (1); and primitive neuroectodermal tumor not otherwise specified (2). Pretreatment imaging studies demonstrated recurrent intracranial parenchymal disease in nine, spinal disease in four, and abnormal radioisotope ventriculography in six. Systemic disease was seen in four children (3 leukemia; 1 non-Hodgkin's lymphoma). All children were treated with systemic chemotherapy and intraventricular chemotherapy. Nine children received radiotherapy to bulky or symptomatic leptomeningeal disease. Median survival was 6 months (range, 4-18 months). Children with hematologic malignancies had superior outcomes compared to children with solid tumors. Three children with leukemic or lymphomatous meningitis are alive and disease free whereas all children with carcinomatous meningitis died. In conclusion, leptomeningeal metastases in children portends a limited survival, and therapies at this time remain palliative except in children with hematologic malignancies.
对15名年龄在4至18岁之间患有柔脑膜转移的儿童进行了肿瘤范围评估，并接受了放疗或化疗。组织学诊断包括：急性淋巴细胞白血病（4例）；间变性星形细胞瘤（1例）；室管膜瘤（2例）；非精原细胞瘤性生殖细胞瘤（1例）；非霍奇金淋巴瘤（1例）；松果体母细胞瘤（1例）；以及未另行指定的原始神经外胚层肿瘤（2例）。治疗前的影像学研究显示，9例有颅内实质疾病复发，4例有脊髓疾病，6例放射性核素脑室造影异常。4名儿童出现全身疾病（3例白血病；1例非霍奇金淋巴瘤）。所有儿童均接受了全身化疗和脑室内化疗。9名儿童因柔脑膜疾病体积较大或有症状而接受了放疗。中位生存期为6个月（范围4至18个月）。血液系统恶性肿瘤患儿的预后优于实体瘤患儿。3例患有白血病或淋巴瘤性脑膜炎的儿童存活且无疾病，而所有患有癌性脑膜炎的儿童均死亡。总之，儿童柔脑膜转移预示着生存期有限，目前的治疗仍然是姑息性的，血液系统恶性肿瘤患儿除外。
