【文献解读】鞘内地塞米松和甲氨蝶呤治疗实体肿瘤的癌性脑膜炎

【文献解读】鞘内地塞米松和甲氨蝶呤治疗实体肿瘤的癌性脑膜炎
2018/1/22 创新医学网

     文章来源：欧尔意 OAE 微信号

     作者 :sofina

     原文出处

     Lv WJ, He JY, Zou YL, Liu YJ, Zhang QQ, Liu X, Bu H. Intrathecal dexamethasone and methotrexate treatment of neoplastic meningitis from solid tumors. Neuroimmunol Neuroinflammation 2015;2(3):162-6.

     DOI:10.4103/2347-8659.160855

     摘要

     目的：实体肿瘤的癌性脑膜炎(NM)是预后不良的恶性肿瘤。鞘内化学疗法是一种可靠的治疗方法，我们已经在利用鞘内地塞米松和甲氨蝶呤(IT DXM和MTX)治疗NM方面获取了一些经验。方法：对肺癌NM(n= 11)，乳腺癌NM(n = 3)，胃癌NM(n = 1)，恶性黑色素瘤(n = 1)，未知癌(n= 7)总计23例患者病历资料进行了回顾性研究。在这些患者中，8例接受IT DXM和MTX治疗，15例患者进入姑息护理组。研究对每组的总生存期(OS)进行了比较，并对病人的特点、症状以及所做的实验室检查进行了分析，以便找出影响OS的风险因素。结果：IT DXM和MTX治疗组的OS显著长于姑息护理组(P = 0.01)。姑息护理组中位生存期(MS)为7.53周(5.50-9.57; n = 15)，IT DXM和MTX组为28.63周(12.50-44.75; n = 8); IT DXM和MTX治疗能够延长NM患者的OS(回归系数= -2.923)，优势比(OR)为0.054(0.09-0.323)。脊髓神经损伤缩短OS(回归系数= 1.595)，OR值为4.928(1.382-17.579)。结论：IT DXM和MTX能够延长患者的MS，可以作为治疗NM的基本方法。诱导治疗时间应该是灵活的且个体化的，在中枢神经系统复发时可以重启诱导治疗。脊髓神经损伤的患者存活期常较短。

     Aim: Neoplastic meningitis (NM) from solid tumors is an advanced malignancy with poor prognosis. Intrathecal chemotherapy is a reliable treatment, and we have obtained some experiences in the treatment of NM with intrathecal dexamethasone and methotrexate (IT DXM and MTX). Methods: Retrospective study of 23 patients with NM from lung cancer (n = 11), breast cancer (n = 3), gastric cancer (n = 1), malignant melanoma (n = 1), unknown cancer (n = 7) was conducted. Among these patients, eight received IT DXM and MTX treatment, and 15 patients were placed into a palliative care group. Overall survival (OS) was compared, and the patients’ characteristics, symptoms, and some laboratory examinations were analyzed to find the risk factors affecting OS. Results: OS of IT DXM and MTX group was significantly longer than that of the palliative care group (P = 0.01). The median survival (MS) of palliative care group was 7.53 weeks (5.50-9.57; n = 15), and of the IT DXM and MTX group, 28.63 weeks (12.50-44.75; n = 8); IT DXM and MTX prolonged the OS of NM patients (regression coefficient = ?2.923), with odds ratio (OR) being 0.054 (0.09-0.323). Spinal nerves damage decreased the OS (regression coefficient = 1.595), with OR being 4.928 (1.382-17.579). Conclusion: IT DXM and MTX have prolonged the patients’ MS, which could be used as a fundamental treatment of NM. Time of induction treatment should be flexible and individualized, and induction treatment could restart when central nervous system relapse. Patients with spinal nerves damage are apt to live shorter.

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