伴骨髓转移的实体瘤患者17例临床分析

An clinical analysis of 17 cases of solid tumers with bone marrow metastatisis

目的研究骨髓转移的实体瘤的临床特征、化疗的疗效与预后。方法 17例确诊骨髓转移癌的实体瘤患者,8例乳腺癌、4例小细胞癌、2例胃癌、3例其他部位肿瘤。分别给于个体化的化疗,并且前2疗程化疗剂量均下调20%,观察不良反应、疗效和生存期。结果治疗2疗程时16例可评价者按照RECIST标准评价疗效:部分缓解8例,稳定5例,疾病进展3例。疾病控制率为13/16(81.3%)。长期追访13例疾病控制者中位生存期为24个月(95%可信区间2.3,45.7个月)。不良反应可以耐受,经处理后不影响继续治疗。结论对于化疗敏感的实体瘤,发生骨髓转移后仍应进行化疗。对于化疗不敏感的肿瘤或者反复化疗耐药者,预后很差,以姑息治疗为主。

Objective To study the clinical characteristics, chemotherapy response, and prognosis of patients with bone marrow metastasis treated by chemotherapy. Method Totally 17 patients, Mcluding 8 cases of breast cancer, 4 cases of small cell cancer, 2 cases of gastric cancer, and 3 of other cancer, were enrolled. Chemotherapy dosages of the first 2 cycles were reduced by 80% standard dose. The side effect, response rate and survival time were studied. Results Among 16 evaluable patients after 2 cycles of chemotherapy, 8 cases achieved partial response （ PR ） , 5 cases had stable disease （SD）, and 3 cases experienced progress disease （PD）. The response rate was 13/16 （81.3%）. Thirteen cases with disease controlled were followed up, and the median overall survival was 24 months. The side effects were slight and acceptable. Conclusion The patients with chemosensitive tumors should be given chemotherapy even if they have bone marrow metastasis. For patients resistant to chemotherapy, the prognosis will be poor, and palliative therapy is preferred.