术后不同放化疗时间窗及程序对高级别脑胶质瘤疗效的影响

目的探讨不同放化疗时间窗及程度对高级别脑胶质瘤（HGG）治疗效果的影响。方法选择HGG患者68例,采用随机数字表法分为化疗＋放化疗＋化疗组（C＋RC＋C）和放化疗＋化疗组（RC＋C）,每组34例。比较2组患者治疗有效率和控制率、无进展生存期（PFS）和总生存期（OS）。结果术后治疗6个月随访,C＋RC＋C组有效率为79．41％,Rc＋c组为52．94％;C＋RC＋C组控制率达88．24％,RC＋C组为67．65％,差异均有统计学意义（χ1^2=5．322,P=0．021;χ2^2=4．191 P=0．041）。经Kapplan—Meier生存曲线分析,C＋RC＋C组中位OS为18．6月,RC＋C组中位OS为16．5月,差异无统计学意义（P=1．145）;C＋RC＋C组的中位PFS为9．5月,RC＋C组中位PFS为8．2月,差异存在统计学意义（P=0．009）。结论HGG患者术后早期替莫唑胺（TMZ）化疗＋同步放化＋辅助化疗可提高治疗有效率,明显延长患者无发展生存期。     

肺腺癌新分类在预测Ⅰb期非小细胞肺癌预后中的价值

[目的]探讨新的肺腺癌分类在判断早期可手术的Ⅰb期非小细胞肺腺癌患者中的预后价值。[方法]回顾性分析168例非小细胞肺癌患者,根据第7版TNM分期明确诊断为Ⅰb期非小细胞肺腺癌。采用Kaplan-Meier法比较不同病理亚型患者的无复发生存期和总生存期。Cox回归分析探讨影响患者无复发生存期和总生存期的影响因素。[结果]168例患者中,无原位腺癌患者,2例患者为微浸润腺癌,51例患者为乳头状为主型,55例患者为腺泡样为主型,24例为微乳头为主型,20例为鳞屑状为主型,12例为实性为主型腺癌,4例为变异性腺癌（其中2例为实性腺癌,2例为胎儿型腺癌）。单因素分析显示,是否淋巴管,血管侵犯（P=0．042）和不同病理类型（P=0．004）是影响患者5年无复发生存的因素。多因素分析显示。病理类型是同时影响患者5年无复发生存和总生存期的惟一因素（P分别为0．002和0．035）。[结论]新肺腺癌分类在预测可手术的Ⅰb期非小细胞肺腺癌的无复发生存和总生存方面有一定的价值。     

非小细胞肺癌肺内转移预后分析

背景与目的 40％以上非小细胞肺癌（NSCLC）确诊即为Ⅳ期，可发生肺内或／和远处转移。不同转移部位对生存期的影响目前报道不多。本研究拟探讨NSCLC患者肺内转移与单一远处血行转移以及肺内转移并其它多部位转移的临床病理特点及生存期差异，从而探讨NSCLC肺内转移的预后相关因素。方法 回顾性分析自1995年10月至2003年12月在我院经病理活检及全面分期检查确诊为Ⅳ期NSCLC、并有完整随访资料的425例患者．其中仅肺内转移而无其它部位转移者（单一肺内转移）81例，单一远处血行转移98例，肺内转移并其它部位转移68例。通过Kaplan-Meier曲线法计算生存率，Log—Rank检验比较三组生存期差异．单因素分析肺内转移的预后因素。结果 81例肺内转移者中位生存期（MST）及1、2、3年生存率（SR）分别为：13个月（95％CI11～15），57％、21％、7％；N1／N2者MST22个月，N3者10个月（P=0．0011）；同侧、对侧及双侧肺内转移者MST及年SR差异无统计学意义（P〉0．05）；单一肺内转移MST及年SR与单一脑或骨转移无显著性差异（P〉0．05），但单一肺内转移生存期长于肺并其它部位转移（MST9个月．1、2、3年SR分别为40％、9．4％、1．5％）（P=0．021）。单因素分析：年龄、病理亚型、分化程度、化疗疗效对单一肺内转移的NSCLC生存期无影响（P〉0．05），性别及淋巴结转移（N1／N2比N3）与生存相关（P=0．018，P=0．001）；将年龄分层进行分析，淋巴结转移（N1／N2比N3）为此组患者的独立预后因素（P=0．002）。在肺并其它部位转移者，转移数目（2vs≥3）系独立预后因素（=0．013）。结论 NSCLC单一肺内转移者生存期与单一脑、骨等远处转移者无显著差异．但长于肺并其它部位转移者。淋巴结转移状况（N1＋2比N3）及远处转移数目（2比≥3）分别影响单一肺内转移及肺并其它部位转移者的预后。     

CT引导下氩氦刀联合阿法替尼对肺腺癌患者的临床疗效研究

目的 探究CT引导下氩氦刀联合化疗或阿法替尼对肺腺癌患者近期疗效与远期生存和复发情况的影响。方法 选择2015年1月至2016年9月于固安县人民医院接受一线治疗的晚期肺腺癌患者100例,随机数字法分为对照组（50例）和阿法替尼组（50例）,在应用CT引导下氩氦刀冷冻治疗的基础上,对照组采用吉西他滨联合顺铂的化疗方案,阿法替尼组采用口服阿法替尼治疗。比较两组患者的近期疗效、总生存期、无进展生存期,局部复发与远处转移情况以及并发症和不良反应发生率。结果 阿法替尼组的客观缓解率、无进展生存期和远处转移时间明显高于对照组（均P＜005）;两组的局部复发时间和并发症发生率差异无统计学意义（P=0070; P=0758）;阿法替尼组的不良反应发生率明显低于对照组（P＜005）。结论 CT引导下氩氦刀联合阿法替尼治疗晚期肺腺癌具有较高的疗效和较好的远期生存情况。     

经颅钻孔引流联合 Ommaya管置入术治疗囊性胶质瘤的临床效果

目的：对囊性胶质瘤患者Ommaya管置入手术与颅钻孔引流联合实施治疗的临床效果进行分析探究。方法将80例囊性胶质瘤患者按照数字表法随机分组,对照组给予三苯氧胺与三维适形放疗实施治疗,试验组给予颅钻孔引流与Ommaya管置入手术实施治疗,对比分析2组治疗效果、不良反应情况。结果试验组的总有效率（92．50％）与对照组（57．50％）相比明显较高,差异有统计学的意义（P＜0．05）。试验组不良反应发生率（5．00％）与对照组（32．50％）相比明显较低,差异有统计学的意义（ P ＜0．05）。试验组患者症状消失率（52．50％）明显高于对照组（25．00％）,差异有统计学意义（P＜0．05）。结论囊性胶质瘤患者Ommaya管置入手术与颅钻孔引流联合实施治疗的临床效果显著,不良反应较少发生,临床意义重大。     

11例肺腺癌脑膜转移的综合治疗

目的 探讨肺腺癌脑膜转移的临床诊断、治疗及预后.方法 收集11例肺腺癌脑膜转移患者的临床资料进行回顾性分析.结果 11例肺腺癌患者均有明确的病理学诊断,脑脊液中均找到癌细胞,11例患者均接受鞘内注射,同时加以不同形式的综合治疗,总生存期(OS)为1.4~26.0个月,中位OS为7.1个月,患者颅内高压及脑膜刺激征均较前不同程度改善.结论 肺腺癌脑膜转移患者给予包括鞘内注射在内的综合治疗能延长患者总生存时间,改善症状.     

吉非替尼与放疗联合替莫唑胺对无症状肺腺癌脑转移治疗的临床疗效

目的：观察吉非替尼单药与放疗联合替莫唑胺治疗肺腺癌伴脑转移的疗效与毒副反应.方法：40例患者随机分为吉非替尼组（Gefitinib组,20例）和放疗联合替莫唑胺组（R＋TMZ组,20例）.比较两组患者近期疗效、总生存期（OS）和毒副反应.结果：两组近期疗效无统计学差异（P＞0.05）.Gefitinib组中位生存期（OS） 15.5个月,R＋TMZ组10.8个月（P＜0.05）.Gefitinib组主要毒副反应为皮疹,R＋TMZ组主要毒副反应是恶心、呕吐.Gefitinib组生活质量高于R＋TMZ组（P＜0.05）.结论：吉非替尼与放疗联合替莫唑胺均可用于肺腺癌伴脑转移的治疗,但吉非替尼组治疗肺腺癌伴脑转移的近期疗效与放疗联合替莫唑胺组相当.吉菲替尼中位生存期优于放疗联合替莫唑胺.吉菲替尼组毒副反应轻微、生活质量明显改善.     

pT1期肺腺癌组织TK1与PCNA和Ki-67表达临床意义对比分析

目的：对比研究增殖指标胸苷激酶1（eytosolic thymidine kinas1,TK1）和增殖细胞核抗原（proliferation cellnu—clear antigen,PCNA）与Ki-67在病理分期T1（pT1）期肺腺癌组织中表达及其临床意义。方法：选取南京军区南京总医院1997—02—01—2007—12—31手术治疗并具有完整病理资料和随访结果的pT1期肺腺癌患者80例,应用免疫组织化学En Vision法检测80例肺腺癌以及20例正常肺组织中TK1、Ki-67及PCNA的表达,对比分析3项标志表达与肺腺癌临床病理特征和预后的相关性。结果：pT1期肺腺癌与正常肺组织中TK1表达率-为15．0％和95．0％,＋为33．8％和5．0％,＋＋为38．8％和0,＋＋＋为12．5％和0,差异有统计学意义,P〈0．001;Ki-67表达率-为46．3％和85．O％,＋为40．0％和15．0％,＋＋为8．7％和0,＋＋＋为5．O％和0,差异有统计学意义,P=0．002;PCNA表达率与正常肺组织差异无统计学意义,P=0．507。TK1表达与淋巴结转移（P=0．009）、临床病理分期（P=0．004）及肿瘤浸润程度（P〈0．001）相关,Ki-67和PCNA表达与上述临床病理特征均无相关性。TK1不同表达组别的5年生存率除-（91．7％）与＋（81．1％）组之间以及＋＋（38．7％）与＋＋＋（50．0％）组之间差异无统计学意义外,其余各表达组别间差异均有统计学意义,而不同PCNA及Ki-67表达组别间的预后差异无统计学意义。Cox模型多因素预后分析显示,TK1表达、淋巴结转移及临床病理分期是独立预后因素。结论：pT1期肺腺癌中,TK1是一项比Ki-67及PCNA更可靠的增殖指标,可作为评估这类肺腺癌侵袭性及预后的参考指标。     

Napsin A在肺腺癌中的表达及临床意义

目的探讨Napsin A对肺腺癌的诊断价值及与肺腺癌分化程度、临床病期和淋巴结转移的关系。方法采用SP免疫组织化学方法检测47例肺腺癌患者的肺癌组织中Napsin A的表达,并与癌旁正常肺组织、46例其他组织学类型的肺癌组织和19例良性肿瘤组织对比。结果肺腺癌组Napsin A表达阳性率87．2％,显著高于非肺腺癌组4．3％（x^2=64．249,P〈0．01）和良性肿瘤组21．1％（x^2=27．317,P〈0．01）,但低于正常肺组织组100％（P〈0．05）;高分化、中分化和低分化肺腺癌组织中Napsin A表达阳性率分别为100％（20／20）、86．7％（13／15）和66．7％（8／12）,三者的阳性率具有显著性差异（x^2=7．489,P〈0．05）;Ⅰ～Ⅱ期腺癌组NapsinA表达阳性率为100％（24／24）,明显高于Ⅲ～Ⅳ期腺癌组73．9％（17／23）,P〈0．01;有淋巴结转移的肺腺癌组织Napsin A表达阳性率为72．7％（16／22）,明显低于无淋巴结转移者100％（25／25）,P〈0．05。结论Napsin A可以作为诊断肺腺癌的特异性肿瘤标记物,是判断肺腺癌恶性程度、临床病期及有无淋巴结转移的重要指标。     

儿童第四脑室肿瘤显微外科治疗及手术后并发症的预防

背景与目的:儿童第四脑室肿瘤术后易出现的枕部皮下积液或假性脑膜膨出、切口脑脊液漏、颅内感染等并发症。本文探讨儿童第四脑室肿瘤手术计划的制订,以提高手术疗效。方法:2006年5月以来26例第四脑室肿瘤患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;经膜髓帆入路手术切除儿童第四脑室肿瘤。结果:所有患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;肿瘤全切23例,次全切除3例,无一例出现缄默症,本手术组无死亡病例。6例颅内感染者得到有效控制,无一例出现脑积水而需要行分流术,未出现一例枕部假性脑膜膨出及切口脑脊液漏等并发症。结论:多数儿童第四脑室肿瘤患者可经膜髓帆入路在不需要切开小脑蚓部的情况下予以肿瘤切除,仅少数患者为了充分显示肿瘤上极而切开小脑下蚓部。术前安置Ommaya囊术后持续外引流,可以有效地预防并发症的发生。     

Ventriculoperitoneal shunt complications in hydrocephalus patients with intracranial tumors: an analysis of relevant risk factors

Patients with intracranial tumors are predisposed to persistent hydrocephalus, often requiring a permanent CSF diversion procedure with shunts. This study reviews the long-term experience with ventriculoperitoneal shunts for the management of hydrocephalus in patients with intracranial tumors. Patients with intracranial tumors who underwent ventriculoperitoneal shunt placement for hydrocephalus from October 1990 to October 2009 were included in this study. During the 19-year period, medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retrospectively for all patients. A total of 187 intracranial tumor patients with hydrocephalus were included. The median follow up was 391 days. Malignant tumors were present in 40% of the patients. Overall shunt failure was 27.8%. Single shunt revision occurred in 13% of the patients and 14% had multiple shunt revision. Tumor histology, age and a procedure prior to shunt placement (ventriculostomy/Ommaya reservoirs) were significantly associated with the shunt revisions. Shunt system replacement and proximal shunt complication were significantly attributed to multiple shunt revisions. The overall shunt revision within 3 months, 6 months, 1 year and 5 years was 17.7%, 18.7%, 19.8% and 24.1%, respectively. The results of the study demonstrate that VP shunting is an effective for the management of hydrocephalus in patients with intracranial tumors. The overall incidence of shunt revision was 27.8%. Age, tumor histology, and a procedure prior to shunt placement (ventriculostomy/Ommaya reservoirs) were significantly associated with the shunt revisions. Additional studies using minimally invasive techniques are being explored for the management of hydrocephalus in patients with intracranial tumors.     

Survival status and prognostic factors of leptomeningeal metastasis from lung adenocarcinoma北大核心CSCD

Objective: To investigate the survival status and prognostic factors of patients with leptomeningeal metastasis (LM) from lung adenocarcinoma. Methods: The survival rate and prognostic factors of 65 patients with LM from lung adenocarcinoma, who had complete follow-up data, were retrospectively analyzed. Results: The median survival time of the 65 patients was 7.4 months,and the 1-year survival rate was 6.2% (4/65). Univariate analysis demonstrated that gender, age, smoking history, timing of LM and whether in combination with brain metastasis had no significant correlations with overall survival (all P > 0.05); while the Eastern Cooperative Oncology Group (ECOG) performance status (PS) score, ventriculo-peritoneal (V-P) shunt, epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) targeted therapy, systemic chemotherapy (SC), whole-brain radiotherapy (WBRT), clinical signs of LM and EGFR gene status were associated with the overall survival (all P < 0.05). Multivariate analysis showed that EGFR gene status, ECOG PS score, SC and V-P shunt were independent prognostic factors of the prognosis of patients with LM from lung adenocarcinoma (all P < 0.05). Conclusion: The overall prognosis of patients with LM from lung adenocarcinoma is poor. The prognosis of patients with LM bearing EGFR mutation is relatively good. EGFR-TKI targeted therapy, SC and V-P shunt can prolong the survival time and improve the prognosis of patients with LM metastasis from lung adenocarcinoma. Copyright © 2017 by TUMOR All rights reserved.     

Safety,Pharmacokinetic and Clinical Activity of Intrathecal Chemotherapy With Pemetrexed via the Ommaya Reservoir for Leptomeningeal Metastases From Lung Adenocarcinoma: A Prospective Phase I Study

IntroductionLeptomeningeal metastasis (LM) is a highly fatal and debilitating complication of lung adenocarcinoma (LUAD) with limited therapeutic options. This study aimed to evaluate the efficacy and toxicities of intrathecal chemotherapy (IC) with pemetrexed via Ommaya reservoir in LUAD with refractory LM.MethodsIn this prospective, single-arm, phase I trial (ChiCTR2000028936), LUAD-LM patients who had progressed after at least two prior treatments were recruited. Pemetrexed from 30 mg to 50 mg was administered on Days 1 and 8 every 3 weeks via Ommaya reservoir. Serial samples of cerebrospinal fluid (CSF) and plasma were obtained for pharmacokinetic studies. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and therapeutic toxicities.ResultsTwenty-three patients were enrolled and analyzed, revealing an ORR of 43.5% (95% CI, 23.2%-63.8%) and DCR of 82.6% (95% CI, 61.2%-95.0%). The median PFS and OS were 6.3 and 9.5 months, respectively. Dose-limiting toxicity was only observed in 2 patients (2/23, 8.7%), and 30 mg pemetrexed was considered as the recommended dose for IC. Pharmacokinetic analysis showed that using Ommaya reservoirs, higher pemetrexed concentrations and prolonged half-lives were achieved in the CSF compared with lumbar puncture (LP).ConclusionsIntrathecal pemetrexed at a dose of 30 mg via Ommaya reservoirs on Days 1 and 8 every 21 days achieved promising disease control and satisfactory survival with moderate toxicities in resistant LUAD-LM, providing a feasible and effective option, especially for the patients who cannot tolerate LP.     

The role of surgery in lung metastases.

AIMS: To evaluate the efficacy of pulmonary metastasectomy in 93 patients with lung metastases (LM) operated on from 1983 to 1997. METHODS: We assessed: location and histological diagnosis of the primary tumour (PT); the extent of pulmonary resection; and disease-free interval (DFI). Survival analysis was undertaken using the Kaplan-Meier method. RESULTS: Surgical complications occurred in eight (9%) patients; two (3%) died in hospital; seven (8%) were operated again because of further LM. In the whole patient group the average survival after metastasectomy was 40 months (median 22 months). The actuarial survival was 44% at 3 years and 35% at 5 years. With metastasectomy we achieved an overall survival after treatment of PT of 87 months (median 58 months). The actuarial survival was 58% at 5 years and 38% at 10 years. The average time between the treatment of PT and metastasectomy DFI was 4 years (median 41 months). Patients with a DFI of more than 2 years tended to live longer (P=0.086). There were 23 patients with non-epithelial and 70 patients with epithelial tumours. Their DFIs were similar (mean 47, median 34 months for non-epithelial and mean 51, median 29 months for epithelial tumours). Of patients with non-epithelial tumours, 38% survived for 5 years and their survival curves were similar. In the group of tumours with the most frequent location, the results of metastasectomy did not differ considerably: 5 year survival rates of 20% for patients with kidney tumours, 28% for colorectal cancer, 30% for soft-tissue sarcoma, 28% for skin melanoma and 18% for breast cancer. CONCLUSIONS: Lung metastasectomy seems to be a safe and efficient method of treatment even for patients who show further metastases. According to our study it seems that, except for LM of breast carcinoma (which has a slightly worse prognosis), the results of surgical resection are not dependent on either the location or the histological pattern of the PT. For this reason patients indicated for operation can be selected according to similar criteria.     

Recurrent lymphomatous meningitis treated with intra-CSF rituximab and liposomal ara-C

Background The most frequent central nervous system complication of systemic non-Hodgkin's lymphoma (NHL) is lymphomatous meningitis (LM). Objective A clinical series to test the feasibility of combining intra-CSF liposomal ara-C and rituximab for the treatment of recurrent LM. Design Clinical series of 14 patients with CSF positive lymphomatous meningitis. Setting Tertiary-care university medical center. Results Fourteen patients with recurrent, cytologically positive lymphomatous meningitis were treated. All 14 received liposomal ara-C and rituximab utilizing an Ommaya reservoir. Six patients also received involved-field radiotherapy (brain only two patients; brain and spine two patients; spine only two patients). Best response to treatment included 10 partial responses and four with progressive disease. Estimated median duration of response was 4.0 months (range 1-6 months). Survival ranged from 1.5 to 7 months with an estimated median of 5 months, four patients remain alive and continue to be followed. Cause of death was progressive neurological disease in 7, systemic disease in 1, and combined systemic and neurological disease in 2 patients. Conclusions The combination of intra-CSF liposomal ara-C and rituximab administered in this schedule appears to have no additive toxicity and has modest palliative activity in patients with recurrent LM.     

Safety of Ommaya reservoirs in children with brain tumors: a 20-year experience with 5472 intraventricular drug administrations in 98 patients

The Ommaya reservoir facilitates repetitive delivery of drugs into the CSF and is a pharmacologically rational system for intrathecal chemotherapy. Because previous studies have found a high rate of infection and other complications we herein studied our experience with this device. Between 1993 and 2013, 98 children with brain tumors aged 3 months to 21 years (38 ≤ 3 years) had an Ommaya reservoir placed. All patients received perioperative antibiotics. Only specially trained personnel that followed standardized guidelines were allowed to access the reservoir. As of April 2014, 5,472 chemotherapy instillations were performed amounting to a median of 36 deliveries (2–280) per reservoir. Ommaya reservoirs were present for 199,956 days and a median of 1,336 days per device. Median survival of the 52 patients still alive is 7.5 years. Only one patient developed an Ommaya reservoir infection (1 %) that could be temporarily sterilized but eventually required Ommaya reservoir explantation. Early complications related to Ommaya reservoir placement occurred in two patients, in one catheter malposition was corrected intraoperatively and in the other kinking of the catheter at the burr-hole required minor surgical correction. Two delayed complications requiring surgical revision included malpositioning of the catheter tip after rapid shrinkage of the ventricles and disconnection of the ventricular catheter after 24 accesses. No leucodystrophic changes occurred along the catheter track. In conclusion, Ommaya reservoirs are safe and complications infrequent providing that all personnel involved in implanting and subsequently accessing the device are specially trained and pay meticulous attention to strict aseptic conditions.     

Combined modality therapy for primary CNS lymphoma.

PURPOSE: Primary CNS lymphoma (PCNSL), formerly rare, is being seen with increased frequency among apparently immunocompetent patients. Conventional treatment has consisted of whole-brain radiotherapy (RT) and corticosteroids, with a median survival of 15 to 18 months and a 3% to 4% 5-year survival. Chemotherapy has been useful in the treatment of recurrent PCNSL. In 1985 we began a treatment protocol using chemotherapy and cranial irradiation for the initial therapy of non-AIDS PCNSL. PATIENTS AND METHODS: Thirty-one patients (group A) completed the combined modality regimen. All had placement of an Ommaya reservoir and received pre-RT systemic methotrexate, 1 g/m2, plus six doses of intra-Ommaya methotrexate at 12 mg per dose. A full course of cranial RT (4,000-cGy whole-brain RT plus a 1,440-cGy boost) was followed by two cycles of high-dose cytarabine (ara-C), with each course consisting of two doses of 3 g/m2 ara-C separated by 24 hours and infused over 3 hours. During this period, 16 additional patients (group R) were treated with RT alone, either because patients refused chemotherapy or RT was initiated before our consultation; all would have been eligible to participate in the protocol. Follow-up extended through April 1, 1991. RESULTS: Group A had a significantly prolonged time to recurrence (median, 41 months) compared with group R (median, 10 months; P = .003). Although median survival was doubled from 21.7 months for group R to 42.5 months for group A, this was not statistically significant because of small sample size. More importantly, group R patients received systemic chemotherapy for recurrent PCNSL, which improved survival. CONCLUSION: The addition of chemotherapy to cranial RT for initial treatment of PCNSL significantly improved disease-free survival and contributed to overall survival; all non-AIDS patients with newly diagnosed PCNSL should be considered for combined modality therapy.     

脑室腹腔分流化疗泵置入术治疗高颅压脑膜转移瘤的临床观察

目的:总结颅内高压的脑膜转移瘤病例的临床资料,探讨腹腔分流+化疗泵置入术在脑膜转移瘤中的治疗作用.方法:对2009-08-2011-07收治的72例脑膜转移病例中30例颅内压增高的患者进行系统的临床资料回顾性分析.结果:30例患者均有头痛等颅内压增高表现,行腰穿检查均＞200 mm H2O.CSF细胞学诊断阳性24例,23例患者接受腹腔分流及化疗泵置入术,7例患者单纯接受腹腔分流术,总生存期为4周～24个月,中位生存期为10个月.结论:脑膜转移瘤是恶性肿瘤严重并发症之一,预后差,颅脑MR结合CSF细胞学检查有助于该病诊断,行腹腔分流+化疗泵置入术及术后经化疗泵泵入化疗药物能明显提高患者生存质量及中位生存期.     

Therapy of CNS leukemia with intraventricular chemotherapy and low-dose neuraxis radiotherapy

Successful treatment of CNS leukemic relapse has been frustrated by frequent local recurrence and eventual marrow relapse. We describe the treatment of meningeal leukemia in 39 children with intrathecal remission induction followed by the placement of an Ommaya reservoir to facilitate the administration and distribution of chemotherapeutic agents into the CSF. Six hundred or 900 rad of craniospinal radiation and maintenance intraventricular and intrathecal chemotherapy was then administered. Systemic reinduction therapy was added in the later cases. Sixteen children (41%) experienced no further events, with 17+ months to 13+ years (median, 25 months) follow-up . Eleven patients (28%) had CNS recurrence, nine (23%) bone marrow (BM) relapse, and two (5%) testicular relapse as the next adverse event. The course of patients with first isolated CNS relapse differed from that of the others. Eleven (69%) of 16 patients treated for first isolated CNS relapse are alive and 9 are event free, while only 35% of patients whose CNS relapse occurred simultaneously or after recurrent disease at other sites are alive (P = .04). Seven of 23 in the later group are event free. The difference is due to the increased incidence of BM relapse in the later group (30% v 6%; P = .04). For patients with first isolated CNS relapse, the life-table median CNS remission duration is 42 months. The projected CNS relapse-free survival and event-free survival 8 to 10 years after CNS relapse are 40% and 32%, respectively. Headache, nausea, and emesis of short duration were frequent during therapy. In three patients, the reservoir had to be removed for infection. No patient suffered neurologic deficit related to the reservoir. The therapy described can reduce the CNS relapse rate with manageable toxicity. Systemic relapse is still a major problem after multiple CNS relapse and in those in whom the CNS relapse follows or is simultaneous with relapse at other sites.     

Subset analysis of data in the Japanese patients with NSCLC from IDEAL 1 study on gefitinib

The multinational, multi-institutional clinical Phase II trial of gefitinib monotherapy, IDEAL (IRESSA Dose Evaluation in Advanced Lung Cancer) 1, included Japanese and non-Japanese patients with advanced non-small-cell lung cancer (NSCLC) pretreated with one or more chemotherapy regimens, at least one including platinum. To investigate whether survival is affected by gender or histological type of cancer, a retrospective, exploratory subset analysis was conducted including only Japanese patients from IDEAL 1 (n = 102 in total, 51 each in 250 and 500 mg/day groups). The median survival time of the 102 patients was 12.0 months and the one year survival rate was 50%. The median survival time was 13.8 months for the 250 mg/day group and 11.2 months for the 500 mg/day group and the one-year survival rate was 57% and 45% respectively. Survival was longer in patients with adenocarcinoma than those with other histological types of cancer, and was longer in those with symptom improvement than without. The median survival time in females was longer than that in males. The results suggest that gefitinib could be superior to classical anticancer agents with regard to not only the response rate but also survival time in patients with NSCLC, particularly adenocarcinoma, previously treated with chemotherapy. Further studies are needed to identify factors affecting survival.