Chamberlain M C, Kormanik P
Neuro-Oncology Service, University of California, San Diego, USA.
Arch Neurol. 1998 Apr;55(4):506-12. doi: 10.1001/archneur.55.4.506.
Leptomeningeal metastases (LM) are increasingly diagnosed as anticancer therapies become more effective and result in prolonged patient survival.
To evaluate survival, cause of death, and treatment-related toxic effects in patients undergoing combined modality therapy for LM of non-small cell lung cancer.
Thirty-two patients (age range, 48-73 years; median, 57 years) with LM attributable to metastatic non-small cell lung cancer were treated prospectively. Neurologic presentation included headache (11 patients), cranial neuropathies (9), ataxia (5), cauda equina syndrome (3), myelopathy (3), meningismus (2), radiculopathy (2), and confusion (1). All patients underwent radiographic evaluation to determine the extent of central nervous system disease followed by radiotherapy (16 patients) and sequential and intraventricular chemotherapy (methotrexate in 32 patients; cytarabine in 16; and thiotepa in 6). Twelve patients received concurrent systemic chemotherapy.
Central nervous system imaging demonstrated interrupted cerebrospinal fluid flow (13 patients), parenchymal brain metastases (9), subarachnoid nodules (8), hydrocephalus (5), and epidural spinal cord compression (2). Cytological responses were seen in 17 patients to first-line chemotherapy, 8 to second-line chemotherapy, and 2 to third-line chemotherapy. Treatment-related toxic effects included 20 patients with aseptic meningitis (grade 2 in 16; grade 3 in 4) and 12 patients with grade 3 or 5 thrombocytopenia or neutropenia (4 related to intraventricular chemotherapy). Median survival was 5 months (range, 1-12 months). Nineteen patients died of progressive LM or combined LM and systemic disease progression. Patients with persistent interruption of cerebrospinal fluid flow fared worse than patients with normal cerebrospinal fluid flow (median survival, 4 vs 6 months; P<.05).
Leptomeningeal metastases in patients with non-small cell lung cancer may be palliated with combined modality therapy; however, therapy and survival is based on the extent of central nervous system disease present at pretreatment evaluation.
随着抗癌治疗变得更加有效并延长患者生存期，软脑膜转移（LM）的诊断越来越多。
评估接受非小细胞肺癌LM综合治疗的患者的生存期、死亡原因及治疗相关毒性作用。
前瞻性治疗32例（年龄范围48 - 73岁；中位年龄57岁）因转移性非小细胞肺癌导致LM的患者。神经系统表现包括头痛（11例）、颅神经病变（9例）、共济失调（5例）、马尾综合征（3例）、脊髓病（3例）、颈项强直（2例）、神经根病（2例）和意识模糊（1例）。所有患者均接受影像学评估以确定中枢神经系统疾病的范围，随后接受放疗（16例）以及序贯和脑室内化疗（甲氨蝶呤32例；阿糖胞苷16例；噻替派6例）。12例患者接受同步全身化疗。
中枢神经系统影像学显示脑脊液流动中断（13例）、脑实质转移瘤（9例）、蛛网膜下腔结节（8例）、脑积水（5例）和硬膜外脊髓压迫（2例）。17例患者对一线化疗有细胞学反应，8例对二线化疗有反应，2例对三线化疗有反应。治疗相关毒性作用包括20例无菌性脑膜炎患者（16例为2级；4例为3级）和12例3级或5级血小板减少或中性粒细胞减少患者（4例与脑室内化疗有关）。中位生存期为5个月（范围1 - 12个月）。19例患者死于进展性LM或LM合并全身疾病进展。脑脊液流动持续中断的患者比脑脊液流动正常的患者预后更差（中位生存期分别为4个月和6个月；P<0.05）。
非小细胞肺癌患者的软脑膜转移可通过综合治疗得到缓解；然而，治疗和生存期取决于预处理评估时存在的中枢神经系统疾病的范围。
