Carcinomatous meningitis in solid tumours.
Carcinomatous meningitis in solid tumours.
复制标题
实体瘤中的癌性脑膜炎。
作者：
Gordon C. Jayson;A. Howell
癌性脑膜炎（CM）是一种罕见的，但破坏性的并发症恶性肿瘤。管理是有争议的，不能作出明确的建议，因为：1）大多数系列包括与不同的中位生存期相关的不同原发性恶性肿瘤引起的CM患者。2)尚未对特定肿瘤类型CM患者的治疗方式进行前瞻性随机研究。3)缓解的定义因报告而异，因此某些缓解率是指CSF中的细胞学变化，而其他缓解率则考虑了临床、细胞学和生化参数。4)报告包括有和无实质转移的患者，两种情况下癌性脑膜炎的自然病史可能不同。实体瘤癌性脑膜炎（不包括白血病和淋巴瘤）的中位生存期约为2-3个月，乳腺癌患者的生存期最长（中位3个月）。目前，患者接受部分或全部神经轴放射治疗，鞘内或静脉化疗，但这些方式对生存或生活质量的相对贡献仍然未知。大约50%的癌性脑膜炎患者死于其他原因，包括全身性疾病。在文献中，很少单独使用患者的两个最重要的终点，神经系统改善和总生存期。许多报告关注缓解的替代标志物，即生化和细胞学数据点，但临床状态与这些参数之间的相关性较差，因为CM中腰椎和脑室CSF之间存在差异以及CSF流动紊乱。目前的文献没有提供明确的指导方针，治疗这种情况。应进行多中心、前瞻性、随机试验，以解决与患者最相关的问题，即神经系统状态和总生存期。
Carcinomatous meningitis (CM) is an uncommon but devastating complication of malignancy. The management is controversial and clear recommendations cannot be made because: 1) Most series include patients with CM that has arisen from different primary malignancies which are associated with different median survival intervals. 2) There have been no prospective randomised investigations of treatment modalities in patients with CM from a particular tumour type. 3) The definition of response varies from one report to another so that some response rates refer to cytological changes in the CSF while others take clinical, cytological and biochemical parameters into account. 4) Reports include patients with and without parenchymal metastases and the natural history of carcinomatous meningitis in the two situations may differ. The median survival of solid tumour carcinomatous meningitis (excluding leukaemia and lymphoma) is approximately 2-3 months and patients with breast cancer have the longest survival (median 3 months). Currently patients are treated with radiotherapy to part or all of the neuraxis with either intrathecal or intravenous chemotherapy but the relative contribution of these modalities to survival or quality of life remains unknown. Approximately 50% of patients with carcinomatous meningitis die from other causes, including systemic disease. The two most important endpoints for the patient, neurological improvement and overall survival, are seldom used in isolation in the literature. Many reports have focused on surrogate markers of response, namely biochemical and cytological data points but the correlation between clinical status and these parameters is poor because of differences between lumbar and ventricular CSF and disturbances of CSF flow in CM. The current literature does not provide clear guidelines for the treatment of this condition. Multicentre, prospective, randomised trials should be conducted that address questions of most relevance to the patient, namely neurological status and overall survival.
影响因子：
45.3
作者：
GROSSMAN, SA;FINKELSTEIN, DM;ETTINGER, DS
通讯作者：
ETTINGER, DS