甲氨蝶呤鞘内注射治疗脑膜癌病疗效和安全性的临床观察

Efficacy and Security of Intrathecal with Methotrexate in the Treatment of Meningeal Carcinomatosis

背景与目的脑膜癌病是中枢神经系统转移瘤的一种少见类型。近年来,随着恶性肿瘤治疗疗效的提高,患者生存期延长,脑膜癌病的发病率逐年增加,目前尚缺乏有效的治疗手段。本研究旨在探讨鞘内注射甲氨蝶呤(methotrexate,MTX)治疗脑膜转移的疗效、安全性和预后。方法对27例脑膜转移患者的临床资料、脑脊液实验室检查进行回顾性分析,并分析鞘注化疗后的不良反应及预后。结果 27例脑膜转移患者接受鞘注化疗后,70.4%获得临床症状缓解,但脑脊液压力和脑脊液生化改变无统计学差异。55.6%患者无不适,25.9%出现下肢麻木、轻微疼痛,无严重不可逆的不良反应发生。本组患者中位生存期4个月。结论鞘内注射MTX可改善脑膜癌病患者临床症状,无严重不良反应发生。

Background and objective Leptomeningeal carcinomatosis is a rare type of metastatic tumors of the central nervous system. In recent years, with the improvement of neoplasms therapies and longer survival of patients by better systemic control, incidence ofleptomeningeal metastases has increased every year. However, there is still lack of effective therapies. The aim of this study is to investigate the efficac）5 security and prognosis of intrathecal chemotherapy with methotrexate （MTX） in the treatment of neoplastic meningitis. Methods A total of 27 patients were enrolled. We investigated clinical features and cerebrospinal fluid （CSF） examination results retrospectively, and analyzed the adverse reactions as well as prognosis after intrathecal chemotherapy. Results All 27 patients were treated by intrathecal MTX, 70.4% had clinical remission, however, there was no significant difference in CSF pressure and CSF biochemical changes. We observed that 55.6% patients were all appropriate, 25.9% appeared lower limb numbness and mild pain, no serious irreversible adverse reactions occurred. Median overall survival was 4 months. Conclusion We suggest that intrathecal administration of MTX is associated with improvement of symptoms of leptomeningeal metastasis patients and no severe adverse events observed.