非小细胞肺癌软脑膜转移通过Ommaya囊注射与腰椎穿刺术给药方式疗效的比较

Efficacy of pemetrexed delivery via ommaya capsule implantation versus lumbar puncture in treatment of leptomeningeal metastasis of non-small cell lung cancer

目的观察通过腰椎穿刺术直接给药以及植入Ommaya囊给药两种鞘内注射培美曲塞途径,对非小细胞肺癌软脑膜转移患者的疗效的影响。方法回顾性分析2021年10月~2023年7月在广西医科大学附属肿瘤医院确诊为非小细胞肺癌伴软脑膜转移32例患者的临床资料。治疗组将接受放疗+培美曲塞鞘内注射+阿美替尼口服治疗脑膜癌病22例,其中ommaya囊组采取ommaya囊室内给药10例,腰穿组采取腰穿注射给药12例。对照组予以放疗+阿美替尼口服治疗10例。治疗Ommaya囊组患者行Ommaya术,术后给予放疗+靶药(阿美替尼)+脑室内化疗(注射培美曲塞);腰穿组患者行放疗+靶药(阿美替尼)+鞘内化疗(注射培美曲塞)。放疗方案:全脑照射每次3 Gy,每周5次,1疗程2周。口服靶药方案:阿美替尼110 mg,每天一次口服使用。化疗培美曲塞30 mg,d1、d8,3周方案,持续化疗至无法耐受或者死亡。结果ommaya囊组与腰穿组在生存时间,治疗前后MRS、Bathel指数评分均优于对照组(P<0.05),治疗组2组间无显著统计学差异(P>0.05)。结论本研究发现鞘内给药包括通过腰椎穿刺术直接给药以及植入Ommaya囊给药两种鞘内注射培美曲塞途径治疗小细胞肺癌软脑膜转移患者优于口服给药,提示这两种给药途径具有较好的应用前景。然而,由于样本量较小等不足,本研究的结论还需要将来更大样本的前瞻性研究来证实。

Objective To compare the efficacy of intrathecal injection of pemetrexed via lumbar puncture and Ommaya capsule implantation for leptomeningeal metastasis in patients with non-small cell lung cancer.Methods The clinical data of 32 patients with non-small cell lung cancer with leptomeningeal metastasis diagnosed at the Affiliated Tumor Hospital of Guangxi Medical University from October 2021 to July 2023 were retrospectively analyzed.The patients were divided into either a treatment group(n=22)or a control group(n=10).Patients in the treatment group were treated with radiotherapy,intrathecal injection of pemetrexed,and oral almonertinib.Among them,10 patients were given pemetrexed via ommaya capsule injection(ommaya group),and 12 were given pemetrexed via lumbar puncture(lumbar puncture group).Ten patients in the control group were treated with radiotherapy and oral almonertinib.Patients in the ommaya group underwent ommaya capsule implantation,and received radiotherapy+target drug(almonertinib)+intraventricular chemotherapy(injection of pemetrexed)after operation.Patients in the lumbar puncture group were treated with radiotherapy+target drug(almonertinib)+intrathecal chemotherapy(injection of pemetrexed).Whole brain irradiation was given at 3 Gy per time,5 times per week for 2 weeks.Oral almonertinib 110 mg was given once daily.The chemotherapy regimen was pemetrexed 30 mg,d1 and d8,every 3 weeks,and was continued until intolerance or death.Results The survival time,modified Rankin scale scores,and Bathel scores before and after treatment in the two treatment groups were better than those in the control group(P<0.05),but there was no significant difference between the two treatment groups(P>0.05).Conclusion Intrathecal administration of pemetrexed,including direct administration through lumbar puncture and ommaya capsule implantation,is superior to oral administration in the treatment of leptomeningeal metastasis of small cell lung cancer,suggesting that these two routes of administration have good application prospects.However,due to the small sample size and other shortcomings,the conclusions of this study need to be confirmed by prospective studies with larger samples in the future.