Optimal treatment of leptomeningeal spread in glioblastoma: analysis of risk factors and outcome
Optimal treatment of leptomeningeal spread in glioblastoma: analysis of risk factors and outcome
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DOI：
10.1007/s00701-015-2344-5
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发表时间：
2015-04-01
影响因子：
2.4
通讯作者：
Seol, Ho Jun
中科院分区：
文献类型：
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作者：
Noh, Jung-Hoon;Lee, Min Ho;Seol, Ho Jun
胶质母细胞瘤（GBM）是成人中最常见的恶性脑肿瘤。尽管治疗取得了进展，但几乎所有患者最终都会经历肿瘤复发。软脑膜扩散（LMS）并不是一种罕见的复发性疾病。然而，LMS的标准管理协议尚未建立。本研究的目的是报告 GBM 患者的 LMS 风险和治疗方式之间的预后。对 2006 年 1 月至 2010 年 12 月期间诊断为 GBM 的 321 例患者进行回顾性分析。其中 75 例患者通过磁共振图像和/或脑脊液细胞学检测发现肿瘤的 LMS。 12 名患者接受了鞘内甲氨蝶呤 (IT-MTX) 化疗。 22 名患者接受了其他挽救治疗。四十一名患者接受了保守治疗。我们分析了 LMS 可能的临床因素。此外，我们检查了几种治疗方式的总生存期和诊断 LMS 后的生存期。在没有 LMS 的患者中，中位总生存期为 479 天，而在患有 LMS 的患者中为 401 天。年龄较小和初始肿瘤大小较大与 LMS 发生率较高有关。肿瘤边缘与心室的距离不影响 LMS。然而，从初次诊断到 LMS 的中位持续时间根据距心室的距离而显着不同。 IT-MTX组的总生存期为583天，在统计学上不长于其他治疗组和保守治疗组。然而，与保守治疗相比，可能存在额外的生存获益。 IT-MTX组的中位生存期为181天，而保守治疗组的中位生存期为91天。LMS的治疗主要是姑息治疗。 IT-MTX 通常是 LMS 的一线治疗方式。 LMS 的预测和预防至关重要，因为其治疗方法有限。应建立进一步的方法来提高治疗效果。
Glioblastoma (GBM) is the most common and malignant brain tumor in adults. Despite therapeutic advances, almost all patients eventually experience tumor recurrence. Leptomeningeal spread (LMS) is not a rare condition of recurrence. However, the standard management protocol of LMS has not been established. The aim of this study is to report the risk of (LMS) and the prognosis between treatment modalities in GBM patients.A retrospective review was conducted of 321 patients who were diagnosed with GBM between January 2006 and December 2010. In 75 patients, LMS of tumor was detected by magnetic resonance image and/or cerebrospinal fluid cytology. Twelve patients underwent intrathecal methotrexate (IT-MTX) chemotherapy. Twenty-two patients underwent other salvage treatments. Forty-one patients underwent conservative management. We analyzed the possible clinical factors for LMS. Further, we examined overall survival and survival after diagnosis of LMS for several treatment modalities.In patients without LMS, median overall survival was 479 days, whereas that in patients with LMS it was 401 days. Younger age and larger initial tumor size were related to more frequent LMS incidence. Proximity between tumor margin and ventricle did not affect LMS. However, median duration from initial diagnosis to LMS was significantly different according to the distance to the ventricle. IT-MTX group's overall survival was 583 days, which is statistically no longer than that of the other treatment group and the conservative management group. However, an additional survival benefit may exist compared to the conservative treatment. The median survival of the IT-MTX group was 181 days compared with 91 days for the conservative management group.Treatment of LMS is mainly palliative. IT-MTX is generally the first-line treatment modality of LMS. Prediction and prevention of LMS is crucial because its treatment has been limited. Further approaches to improve the therapeutic effect should be established.