摘要
目的:通过分析软脑膜转移瘤的临床表现和不同治疗方案的疗效,评价该病的诊断要点、首选的影像学检查方法和确诊指标,探讨目前可行的最佳治疗方案。方法:39例软脑膜转移瘤患者,全部行CT平扫,其中29例行增强扫描;35例行MRI平扫,其中26例行增强MRI扫描;给予放射治疗+鞘内化疗32例,单行鞘内化疗3例,单行放射治疗2例,支持、对症治疗2例。结果:增强MRI扫描显示为4种表现:软脑膜受累、硬膜受累、脊膜受累及脑水肿,33例行腰椎穿刺的患者显示18例蛛网膜下腔开放压力升高,其中16例查见癌细胞;放疗+鞘内化疗组平均生存7周,单纯鞘内化疗组平均生存4.5周,局限性脑膜转移灶单纯放射治疗,平均生存31.5周,对症、支持治疗组,平均生存4天。结论:对软脑膜转移的早期诊断和及时、正确的治疗可以防止神经系统进一步损害的发生,延长患者的生存时间。增强MRI扫描是首选的影像学检查方法,腰穿CSF细胞学检查为确诊的重要手段,受累区的放射治疗和鞘内化疗是其主要的治疗措施。
Objective: The key points of identification, valuable methods of imaging studies and accuracy diagnosis, as well as the optimum management protocol related to Leptomeningeal Carcinomatosis (LC) were assessed by comparing the clinical manifestations, treatment results in different treatment interventions. Methods: Thirty-nine cases of LC were evaluated in this study, CT scan without and with contrast-enhancement applied in 39 and 29 cases, and MRI without enhancement and gadolinium-enhanced MRI(Gd-MRI), on the other hand, were employed in 35 and 26 patients, respectively; the management of LC includes radiation therapy with intrathecal chemotherapy (32 cases), intrathecal chemotherapy (3 cases), radiation therapy (2 cases) and supportive measures only in 2 patients. Results: Positive Gd-MRI appearances were classified into 4 groups: Pure LC in group 1, dural LC and spinal LC in group 2 and 3, respectively, and group 4 had normal Gd-MRI except for hydrocephalus. Elevated opening pressure in 18 of all the 33 patients after lumbar puncture, and presence of carcinoma cells in the cerebrospinal fluid (CSF) in 16 of them. The average survival time are 7 weeks, 4.5 weeks, 31.5 weeks and 4 days with using the four treatment interventions mentioned above, respectively. Conclusions: Neurological complication improvement and prolongation of survival of LC can be acquired with increased awareness and optimum management protocol applied. Gd-MRI and CSF cytology should be considered firstly when LC been suspected, and patients most likely benefit from radiation therapy to symptomatic sites and intrathecal chemotherapy.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2005年第2期83-86,共4页
Chinese Journal of Clinical Oncology
关键词
软脑膜转移放射疗法鞘内化疗
Leptomeningeal Carcinomatosis Radiotherapy Intrathecal chemotherapy
