消化道恶性肿瘤合并脑转移瘤的临床观察

Clinical study of brain metastasis from digestive system neoplasms

目的探讨消化道恶性肿瘤脑转移瘤的临床病理特征和治疗措施。方法回顾性分析1996年1月至2012年1月19例消化道恶性肿瘤脑转移瘤患者的临床表现、影像学特征、治疗和预后情况,并结合文献进行复习。结果 19例患者中,17例出现不同的神经系统症状。增强MRI或CT显示,脑转移瘤病灶中度或明显强化,周边水肿明显,部分瘤体呈囊性病变。治疗上采用立体定向放疗、手术、全脑放疗、囊性转移瘤穿刺、全身化疗等多措施联合的方法。19例患者的脑转移瘤病灶得到不同程度的控制,14例患者神经系统症状改善。全组中位总生存时间为13.6个月,1年生存率为57.9%。结论消化道恶性肿瘤脑转移瘤患者神经系统症状多样,可采用以局部治疗为主的综合治疗。

Objective To investigate the clinicopathologic characteristics and treatment in patients with brain metastasis from digestive system neoplasms. Methods Nineteen digestive system neoplasms patients with brain metastasis from Jan 1996 to Jan 2012 were retrospectively analyzed. Clinical and image characteristics, treatment and prognosis were analyzed retrospectively. Meanwhile the related literatures were reviewed. Results There were various nervous system symptoms in 17 patients. Enhanced MRI or CT scan showed that there were moderate or significant changes in brain metastasis density and significant edema in tumor peripheral and cystic change in some brain metastasis. The combined therapy of stereotactie radiotherapy, surgery, whole brain radiotherapy, stereotaetie as- piration and chemotherapy were applied in these patients. These brain metastasis lesions were controlled at different degrees in all the patients, and nervous system symptoms got improved in 14 patients. The median overall survival of 19 patients was 13.6 months and the 1-year survival rate was 57. 9%. Conclusion Clinical manifestations of digestive system neoplasms with brain metastasis were compli- cated. Local therapy based treatment can be applied.