埃克替尼联合蛛网膜下腔埋入式输注系统治疗肺腺癌脑膜转移的临床观察

  目的  观察埃克替尼联合蛛网膜下腔埋入式输注系统治疗肺腺癌脑膜转移的临床疗效及不良反应。  方法  回顾性分析2011年3月至2015年9月就诊于青岛市肿瘤医院肺腺癌脑膜转移患者7例，予以蛛网膜下腔埋入式输注系统降颅压，联合口服埃克替尼125mg，3次/d，直至疾病进展（progressive disease，PD）或出现不能耐受的不良反应。治疗4周后结合临床症状、脑脊液肿瘤标志物及颅脑MRI增强扫描来评价疗效。  结果  7例可评价肺腺癌患者中，完全缓解（complete response，CR）为0例，部分缓解（partial response，PR）为2例，疾病稳定（stable disease，SD）为4例，PD为1例。其中1例患者PD，治疗1个月后死亡，其余患者生存期均≥4个月。埃克替尼常见的副反应有皮疹、腹泻，均为Ⅰ~Ⅱ度，未见腹壁局部蛛网膜下腔引流管处感染。  结论  埃克替尼联合蛛网膜下腔埋入式输注系统治疗晚期肺腺癌疗效好，可以显著改善肺腺癌患者的临床症状及生存质量，不良反应较小、易耐受，值得临床推广。 

Clinical research of icotinib combined with subarachnoid space implantable pump for the treatment of leptomeningeal metastases from lung adenocarcinoma

Objective: To evaluate the clinical efficacy and side effects of icotinib combined with a subarachnoid space implantable pump for the treatment of leptomeningeal metastases (LM) from lung adenocarcinoma. Methods:Seven cases of LM from lung adeno-carcinoma with epidermal growth factor receptor mutation were included in the study from March 2011 to September 2015. With the aid of anesthetists, all patients were implanted with subarachnoid space implantable pumps to drain the cerebrospinal fluid (CSF) and then treated with icotinib (125 mg, three times a day) until disease progression or unacceptable toxicities. After 4 weeks, the efficacy and tolerability of icotinib were evaluated on the basis of symptoms, tumor markers from CSF, and brain gadolinium-enhanced magnet-ic resonance imaging scans. Results:Among the seven patients evaluated, no patient had complete response, two patients had partial response, four had stable disease, and one had progression. The patient who was progressive died at a month after therapy. The sur-vival time of all the other patients was more than 4 months. The common adverse effects of icotinib were skin rash and diarrhea, main-ly in grades 1 and 2. No infection of the local subarachnoid drainage tube was found in the abdominal wall. Conclusion:Icotinib com-bined with a subarachnoid space implantable pump for the treatment of LM from lung adenocarcinoma may be effective, and the tox-icities are tolerable. This method could also obviously alleviate the clinical symptoms and improve the quality of life of the patients, worthy of further study.