难治性小细胞肺癌脑膜转移伴脑转移瘤一例

doi:10.3969/j.issn.1672-6731.2019.11.011

中国现代神经疾病杂志 ›› 2019, Vol. 19 ›› Issue (11): 870-875. doi: 10.3969/j.issn.1672-6731.2019.11.011

2 难治性小细胞肺癌脑膜转移伴脑转移瘤一例

马玉超¹, 肖建平¹, 张红梅², 万丽娟², 刘姗³, 刘昂斯⁴

1. 100021 国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院放射治疗科;
2. 100021 国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院放射影像诊断科;
3. 100021 国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院放射综合科;
4. 100021 国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院放射神经外科

收稿日期:2019-11-14 出版日期:2019-11-25 发布日期:2019-11-25
通讯作者: 肖建平,Email:jpxiao8@163.com
基金资助:
国家科技重大专项课题（项目编号：2016YFC0904603）；中国癌症基金会“北京希望马拉松”专项基金资助项目（项目编号：LC2014A05）

Refractory brain metastases and leptomeningeal metastases from small cell lung cancer: one case report

MA Yu-chao¹, XIAO Jian-ping¹, ZHANG Hong-mei², WAN Li-juan², LIU Shan³, LIU Ang-si⁴

1 Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College;National Cancer Center;National Clinical Research Center for Cancer, Beijing 100021, China;
2 Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College;National Cancer Center;National Clinical Research Center for Cancer, Beijing 100021, China;
3 Department of General Treatment, Chinese Academy of Medical Sciences and Peking Union Medical College;National Cancer Center;National Clinical Research Center for Cancer, Beijing 100021, China;
4 Department of Neurosurgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College;National Cancer Center;National Clinical Research Center for Cancer, Beijing 100021, China

Received:2019-11-14 Online:2019-11-25 Published:2019-11-25
Contact: XIAO Jian-ping (Email: jpxiao8@163.com)
Supported by:
This study was supported by the National Science and Technology Major Project (No. 2016YFC0904603) and "Beijing Hope Run" Special Fund of Cancer Foundation of China (No. LC2014A05).

摘要/Abstract

摘要：

目的报告1例难治性小细胞肺癌脑膜转移伴脑转移瘤患者的诊断与治疗经过。方法与结果 1例44岁男性广泛期小细胞肺癌患者，经根治性放射治疗、药物化疗和预防性脑照射后1年6个月出现脑膜转移伴脑转移，采取多学科诊疗模式即螺旋断层放射治疗联合替莫唑胺同步化疗、甲氨蝶呤+地塞米松鞘内注射化疗和全身系统性治疗，脑转移后生存期为16个月，死于颅外病变进展。结论对于难治性小细胞肺癌脑和（或）脑膜转移患者，应积极采取多学科诊疗模式，合理应用多种治疗方法、兼顾综合治疗与个体化治疗。

关键词: 小细胞肺癌, 肿瘤转移, 脑膜肿瘤, 脑肿瘤, 放射疗法, 抗肿瘤联合化疗方案

Abstract:

Objective To summarize the diagnosis and treatment of refractory brain metastases and leptomeningeal metastases from small cell lung cancer (SCLC). Methods and Results An extensive stage SCLC male patient (44-year-old) with diffuse parenchymal meningeal metastases and large volume brain metastasis was treated with muti-disciplinary team (MDT), namely precise helical tomotherapy with concurrent temozolomide chemotherapy, combined with intrathecal chemotherapy and systemic therapy. After intracranial recurrent, intrathecal chemotherapy and radiotherapy were used to release the symptoms. At last, this patient died of extracranial disease and the survival time after the diagnosis of brain metastases was 16 months. Conclusions For treatment of brain or leptomeningeal metastases, comprehensive and individualized treatment are needed, and MDT treatment discussion is highly recommended.

Key words: Small cell lung carcinoma, Neoplasm metastasis, Meningeal neoplasms, Brain neoplasms, Radiotherapy, Antineoplastic combined chemotherapy protocols

马玉超, 肖建平, 张红梅, 万丽娟, 刘姗, 刘昂斯. 难治性小细胞肺癌脑膜转移伴脑转移瘤一例[J]. 中国现代神经疾病杂志, 2019, 19(11): 870-875.

MA Yu-chao, XIAO Jian-ping, ZHANG Hong-mei, WAN Li-juan, LIU Shan, LIU Ang-si. Refractory brain metastases and leptomeningeal metastases from small cell lung cancer: one case report[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2019, 19(11): 870-875.

http://journal11.magtechjournal.com/cjcnn/CN/Y2019/V19/I11/870

参考文献

[1] Seute T, Leffers P, ten Velde GP, Twijnstra A. Neurologic disorders in 432 consecutive patients with small cell lung carcinoma[J]. Cancer, 2004, 100:801-806.
[2] Goncalves PH, Peterson SL, Vigneau FD, Shore RD, Quarshie WO, Islam K, Schwartz AG, Wozniak AJ, Gadgeel SM. Risk of brain metastases in patients with nonmetastatic lung cancer:Analysis of the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) data[J]. Cancer, 2016, 122:1921-1927.
[3] Machie TR, Holmes T, Swerdloff S, Reckwerdt P, Deasy JO, Yang J, Paliwal B, Kinsella T. Tomotherapy:a new concept for the delivery of dynamic conformal radiotherapy[J]. Med Phys, 1993, 20:1709-1719.
[4] Ma YC, Xiao JP, Bi N, Xu YJ, Tian Y, Zhang HM, Zhang Y, Liu QF, Deng L, Wang WQ, Zhao RZ, Yang SR, Yi JL, Li YX. Whole-brain irradiation with simultaneous integrated boost by helical tomotherapy for multiple brain metastases:dosimetric and clinical analyses[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2018, 27:435-440.[马玉超,肖建平,毕楠,徐英杰,田源,张红梅,张烨,刘清峰,邓垒,王文卿,赵瑞芝,杨斯苒,易俊林,李晔雄. HT全脑+病灶同步推量放疗多发性脑转移瘤剂量学及临床分析[J].中华放射肿瘤学杂志, 2018, 27:435-440.]
[5] van Rijn J, Heimans JJ, van den Berg J, van der Valk P, Slotman BJ. Survival of human glioma cells treated with various combination of temozolomide and X-rays[J]. Int J Radiat Oncol Biol Phys, 2000, 47:779-784.
[6] Chang JE, Khuntia D, Robins HI, Mehta MP. Radiotherapy and radiosensitizers in the treatment of glioblastoma multiforme[J]. Clin Adv Hematol Oncol, 2007, 5:894-902.
[7] van Nifterik KA, van den Berg J, Stalpers LJ, Lafleur MV, Leenstra S, Slotman BJ, Hulsebos TJ, Sminia P. Differential radiosensitizing potential of temozolomide in MGMT promoter methylated glioblastoma multiforme cell lines[J]. Int J Radiat Oncol Biol Phys, 2007, 69:1246-1253.
[8] NCCN clinical practice guidelines in oncology:small cell lung cancer[DB/OL]. 2018[2019-10-10]. http://nccn.org.
[9] Ma W, Li N, An Y, Zhou C, Bo C, Zhang G. Effects of temozolomide and radiotherapy on brain metastatic tumor:a systematic review and Meta-analysis[J]. World Neurosurg, 2016, 92:197-205.
[10] Bi N, Ma Y, Xiao J, Zhang H, Xu Y, Tian Y, Li J, Zhang Y, Liu Q, Wang K, Deng L, Wang W, Chen X, Liu F, Zhao R, Yang S, Huang X, Yi J, Hu C, Li Y. A phase Ⅱ trial of concurrent temozolomide and hypofractionated stereotactic radiotherapy for complex brain metastases[J]. Oncologist, 2019, 24:E914-920.
[11] Ma YC, Xiao JP, Bi N, Zhang HM, Xu YJ, Zhang Y, Liu QF, Deng L, Wang WQ, Liu F, Wang K, Zhao RZ, Yang SR, Yi JL, Li YX. Case-control study of fractionated stereotactic radiotherapy combined with temozolomide for large brain metastases[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2018, 27:348-353.[马玉超,肖建平,毕楠,张红梅,徐英杰,张烨,刘清峰,邓垒,王文卿,刘峰,王凯,赵瑞芝,杨斯苒,易俊林,李晔雄. FSRT联合替莫唑胺治疗大体积脑转移瘤的对照研究[J].中华放射肿瘤学杂志, 2018, 27:348-353.]
[12] Wu X, Li JL, Xiao JP, Yang BY, Yu L, Wu XM, Wan JH, Xu HY, Kong JX. Efficacy and security of intrathecal with methotrexate in the treatment of meningeal carcinomatosis[J]. Zhongguo Fei Ai Za Zhi, 2016, 19:252-256.[吴熙,李俊岭,肖建平,杨渤彦,于雷,吴晓明,万经海,徐海燕,孔建新.甲氨蝶呤鞘内注射治疗脑膜癌病疗效和安全性的临床观察[J].中国肺癌杂志, 2016, 19:252-256.]
[13] Le Rhun E, Weller M, Brandsma D, Van den Bent M, de Azambuja E, Henriksson R, Boulanger T, Peters S, Watts C, Wick W, Wesseling P, Rudà R, Preusser M; EANO Executive Board and ESMO Guidelines Committee. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours[J]. Ann Oncol, 2017, 28(Suppl 4):84-99.

[1]	宫剑. 积极促进我国小儿神经外科的发展[J]. 中国现代神经疾病杂志, 2023, 23(5): 383-387.
[2]	王军成, 赵岳阳, 马东明. 我国脑肿瘤专病人脑组织资源库建设意义及进展[J]. 中国现代神经疾病杂志, 2022, 22(7): 635-640.
[3]	李智. 应关注颅内SMARCB1/INI-1缺陷型肿瘤的病理诊断与鉴别诊断：《罕见松果体区骨外黏液样软骨肉瘤》有感[J]. 中国现代神经疾病杂志, 2022, 22(12): 1068-1069.
[4]	丁威, 龚旋, 杨魁, 李春涛, 冯松山, 黄正, 周鸿书, 刘志雄, 李臻琰. 内镜下经颅脑桥小脑角区肿瘤切除术手术要点分析[J]. 中国现代神经疾病杂志, 2021, 21(8): 640-644.
[5]	毛志钢, 魏鑫, 陈金平, 李永浮, 王海军. 内镜下扩大经鼻蝶入路手术中海绵窦神经电生理监测初探[J]. 中国现代神经疾病杂志, 2021, 21(8): 651-658.
[6]	王俊华, 张玉琪, 张庆琳, 刘伟, 李杰飞, 陈拓宇. 术前化疗在儿童颅内恶性肿瘤中的应用[J]. 中国现代神经疾病杂志, 2021, 21(5): 416-422.
[7]	李竹君, 毛璐宁, 熊佶, 王鑫, 卢韶华, 刘颖. 肺腺癌脑转移病理学特征及人类间变性淋巴瘤激酶和表皮生长因子受体诊断价值[J]. 中国现代神经疾病杂志, 2021, 21(4): 272-280.
[8]	石易鑫, 马文斌, 王裕. 基于美国SEER数据库的儿童胶质瘤临床特点和预后分析[J]. 中国现代神经疾病杂志, 2021, 21(3): 147-155.
[9]	王月坤, 刘磊, 陈琬琦, 王裕, 马文斌. 脑转移瘤患者单纯手术治疗与手术联合术后脑部放疗对比分析[J]. 中国现代神经疾病杂志, 2021, 21(3): 162-169.
[10]	范冲竹, 李海南, 向璇, 邓达标, 李业海, 匡祖颖, 李智. 易误诊为脑肿瘤的颅内静脉窦血栓形成[J]. 中国现代神经疾病杂志, 2021, 21(12): 1089-1094.
[11]	刘梅, 穆宁, 马春华, 李金铎, 李林, 姜镕. 双倍剂量埃克替尼治疗EGFR基因敏感突变肺腺癌柔脑膜转移疗效初探[J]. 中国现代神经疾病杂志, 2021, 21(11): 1001-1006.
[12]	穆宁, 马春华, 李金铎, 刘梅, 李林, 姜镕. 阿法替尼治疗EGFR G719A突变的肺腺癌脑膜转移一例报道并文献复习[J]. 中国现代神经疾病杂志, 2020, 20(6): 551-555.
[13]	漆松涛. 这里的黎明静悄悄：一篇呐喊式导读[J]. 中国现代神经疾病杂志, 2020, 20(4): 253-254.
[14]	梅芬, 邱若薇, 麦益颖, 陈舒娴, 刘思洁, 闵旭东, 尹铸豪, 包赟, 漆松涛. 儿童脑肿瘤治疗历史、现状及展望[J]. 中国现代神经疾病杂志, 2020, 20(4): 258-262.
[15]	韩磊, 何子俊, 方陆雄, 宋烨. 颅内生殖细胞肿瘤标志物研究进展[J]. 中国现代神经疾病杂志, 2020, 20(4): 263-269.

选择文件类型/文献管理软件名称

选择包含的内容

2 难治性小细胞肺癌脑膜转移伴脑转移瘤一例

Refractory brain metastases and leptomeningeal metastases from small cell lung cancer: one case report

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 难治性小细胞肺癌脑膜转移伴脑转移瘤一例

Refractory brain metastases and leptomeningeal metastases from small cell lung cancer: one case report

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价