摘要
目的探讨体能状态评分≥3分晚期非小细胞肺癌(NSCLC)脑膜转移患者的治疗方法、安全性以及预后。方法回顾性分析2016年11月至2018年9月武汉大学人民医院收治的6例NSCLC脑膜转移患者的临床资料,观察疗效及不良反应,并进行预后分析。结果6例患者中,男性1例,女性5例,中位年龄57岁(46~74岁)。确诊时均为肺腺癌Ⅳ期;3例表皮生长因子受体(EGFR)第21号外显子突变,2例第19号外显子突变;1例间变性大细胞淋巴瘤激酶(ALK)融合突变。肺腺癌治疗后进展出现脑膜转移的时间窗:3例>12个月,3例<12个月,平均为20.3个月。出现脑膜转移时,体能状态评分均≥3分,6例头颅磁共振成像均显示软脑膜线性强化。1例脑脊液中发现癌细胞。4例接受贝伐珠单抗联合EGFR-酪氨酸激酶抑制剂(TKI)治疗,1例口服EGFR-TKI治疗,1例口服EGFR-TKI联合替莫唑胺治疗。患者中位总生存时间9个月(2~13个月),中位无进展生存时间6个月(2~11个月)。结论肺腺癌可能易出现脑膜转移;体能状态评分≥3分的NSCLC脑膜转移患者口服靶向药物联合贝伐珠单抗耐受性好,安全性高,疗效较好。
Objective To investigate the treatment,safety and prognosis of advanced non-small cell lung cancer patients with leptomeningeal metastasis and performance status score more than 3.Methods The clinical data of 6 NSCLC patients with leptomeningeal metastasis admitted to the People's Hospital of Wuhan University from November 2016 to September 2018 were analyzed retrospectively.The curative effect and adverse reactions were observed,and the prognosis was analyzed.Results There were 5 females and 1 male among 6 patients.The median age was 57 years old(46-74 years old).All 6 patients were diagnosed as stageⅣlung adenocarcinoma.There were 3 patients with epidermal growth factor receptor(EGFR)exon 21 mutation,2 patients with exon 19 mutation and one with anaplastic lymphoma kinase(ALK)fusion mutation.The time window of leptomeningeal metastasis occurred after the progression of adenocarcinoma of lung:3 cases was more than 12 months,the other 3 cases was less than 12 months,and the average was 20.3 month.Performance status score was more than 3 when leptomeningeal metastasis occurred.The brain magnetic resonance imaging of 6 patients showed linear enhancement of leptomeningeal,cancer cells were found in cerebrospinal fluid in one case,4 cases were treated with a combination of bevacizumab and EGFR-tyrosine kinase inhibitor(EGFR-TKI),1 case was treated with oral administration of EGFR-TKI,1 case was treated with oral administration of EGFR-TKI combined with temozolomide.The median overall survival(mOS)was 9 months(2-13 months),and the median progression free survival was 6 months(2-11 months).Conclusion Lung adenocarcinoma may be prone to leptomeningeal metastasis;for NSCLC patients with leptomeningeal metastasis and performance status score more than 3,a combination of EGFR-TKI and bevacizumab has good tolerance,high safety and considerable curative effect.
作者
高熠
石薇
柯少波
陈佳梅
邱虎
韩琛
龚毅
赵文思
汪晨宇
蔡高科
陈永顺
Gao Yi;Shi Wei;Ke Shaobo;Chen Jiamei;Qiu Hu;Han Chen;Gong Yi;Zhao Wensi;Wang Chenyu;Cai Gaoke;Chen Yongshun(Department of Oncology,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《肿瘤研究与临床》
CAS
2020年第9期618-621,共4页
Cancer Research and Clinic
关键词
癌
非小细胞肺
腺癌
脑膜肿瘤
肿瘤转移
体能状态评分
蛋白激酶抑制剂
Carcinoma,non-small-cell lung
Adenocarcinoma
Meningeal neoplasms
Neoplasm metastasis
Performance status score
Protein kinase inhibitors
