Radiotherapy of the neuroaxis for palliative treatment of leptomeningeal carcinomatosis
Radiotherapy of the neuroaxis for palliative treatment of leptomeningeal carcinomatosis
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DOI：
10.1007/pl00002398
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发表时间：
2001-04-01
影响因子：
3.1
通讯作者：
Sautter-Bihl, ML
中科院分区：
文献类型：
--
作者：
Hermann, B;Hültenschmidt, B;Sautter-Bihl, ML
背景：软脑膜癌病发生在约5%的实体瘤中，可能严重影响生活质量。本研究的目的是评估颅脊髓放射联合或不联合鞘内化疗的可行性及其在症状缓解和生存方面的疗效。（平均年龄46岁;九例乳腺癌，五例肺癌，一例肾细胞癌，1例原发部位不明的肿瘤），在原发肿瘤诊断的中位间隔5个月后发生软脑膜癌病（0-300个月）在1995年10月至2000年5月期间接受了颅脊髓照射。中位总剂量为36戈伊（1.6-2.0戈伊）。结果：中位生存期12周，单纯放疗后8周，综合治疗后16周。14例患者死于疾病。11名患者（68%）在放疗期间或完成后不久出现神经系统症状消退。7例患者恢复行走能力，6例疼痛减轻，3例膀胱和排便失禁消退。3例患者症状进展，2例患者无变化。副作用为：骨髓抑制（CTC）I级：n = 2，II级：n = 4，III级：n = 4例患者和IV级：n = 1。9例患者有吞咽困难，7例粘膜炎，3例恶心。结论：脑脊髓放射治疗是姑息治疗软脑膜癌病的有效方法。由于患者人数少，因此可以得出任何明确的结论，综合治疗似乎上级单纯放疗。
Background: leptomeningeal carcinomatosis occurs in about 5% of solid tumors and may seriously compromise quality of life. Aim of the present study was to evaluate the feasibility of craniospinal irradiation with and without intrathecal chemotherapy and its efficacy with regard to symptom palliation and survival.Patients and Methods: 16 patients (mean age 46 years; nine breast cancers, five lung cancers, one renal cell cancer, one tumor of unknown primary site) with Leptomeningeal carcinomatosis occurring after a median interval from primary tumor diagnosis of 5 months (0-300 months) received craniospinal irradiation between October 1995 and May 2000. The median total dose was 36 Gy (a 1.6-2.0 Gy). Ten patients were additionally treated with intrathecal methotrexate (15 mg per cycle, 2-8 cycles).Results: Median survival was 12 weeks, 8 weeks after radiotherapy alone, 16 weeks after combined modality treatment. 14 patients died from disease. Eleven patients (68%) experienced regression of their neurological symptoms during or soon after completion of radiotherapy. Seven patients regained their ability to walk, six had pain reduction, three regression of bladder and bower incontinence. In three patients symptom progression and in two patients no change occurred. Side effects were: myelo-suppression (CTC) Grade I: n = 2, Grade II: n = 4, Grade III: n = 4 patients and Grade IV: n = 1. Nine patients had dysphagia, seven mucositis, three suffered from nausea. No Late toxicity was observed.Conclusion: Craniospinal radiotherapy is feasible and effective for palliative treatment of leptomeningeal carcinomatosis. As far as the small patient number permits any definite conclusions, combined modality treatment seems superior to irradiation alone.