脑膜癌病鞘内化疗的分析

Observational analysis of intrathecal therapy for treating leptomeningeal metastases

目的本研究旨在探讨鞘内注射甲氨蝶呤(MTX)、阿糖胞苷(Ara-C)、培美曲塞治疗脑膜癌病(MC)的近期疗效、安全性和预后。方法对54例脑膜癌MC转移患者的临床资料、脑脊液(CSF)实验室检查进行分析,并分析鞘注化疗后的不良反应及预后。结果54例MC转移患者接受鞘内注射化疗后,73.4%获得临床症状缓解,73.5%患者颅内压力下降至正常,52.8%患者CSF细胞学转阴。64.8%患者无不适,22.2%出现轻度不良反应。鞘内化疗能明显降低MC患者CSF白细胞数、肿瘤细胞数及CSF蛋白质水平,~均P<0.05。本组患者中位生存期9.1个月,年龄、性别及治疗前颅内压对鞘内注射患者生存期均无影响,但鞘内注射次数≥10次组生存期明显延长,~均P<0.05。结论鞘内注射治疗可改善MC患者(P<0.05)临床症状、降低颅内压,可显著减少CSF肿瘤细胞数及脑膜损害程度,接受足疗程的鞘内化疗能明显延长生存期,严重不良反应发生率低。

Objective The aim of this study was to investigate the recent efficacy,safety,and prognosis of intrathecal methotrexate,cytarabine and pemetrexed in the treatment of leptomeningeal metastases.Methods The clinical data and cerebrospinal fluid(CSF)laboratory tests from 54 patients with leptomeningeal metastases were analyzed,and the adverse effects and prognosis after intracranial chemotherapy were analyzed.Results After 54 patients with leptomeningeal metastases received intracranial chemotherapy,73.4%obtained clinical symptomatic relief,73.5%had intracranial pressure decreased to normal,and 52.8%had cerebrospinal fluid cytology turned negative.64.8%of patients had no discomfort and 22.2%experienced mild adverse effects.Intrathecal chemotherapy can significantly lower cerebrospinal fluid leukocyte and tumor cell counts and cerebrospinal fluid protein levels in patients with meningeal carcinomatosis(MC),with all P<0.05.The median survival of our patients was 9.1 months,age,gender and pretreatment intracranial pressure had no effect on the survival of patients with intrathecal injections,but the survival of the group with≥10 intrathecal injections was significantly prolonged,with all P<0.05.Conclusion Intrathecal injection therapy can improve clinical symptoms and reduce increased intracranial pressure in patients with MC,and can significantly reduce the degree of cerebrospinal fluid tumor cells and meningeal damage,and receiving a sufficient course of intrathecal chemotherapy can significantly improve survival,with a low incidence of serious adverse effects.