| Objective: Meningeal carcinomatosis(MC)is one of a central nervous system diseases,which is caused by a variety of malignant cancer metastasis to the pia mater or subarachnoid space.This metastatic condition can be observed in 5%~10% patients with solid tumors.MC is a serious neurological complication for late stage cancer patients with high disability and death rates,so the prognosis is poor.There is not an unified treatment plan at present.This research aims to evaluate the clinical efficacy of intrathecal chemotherapy in treatment of MC and discuss the key factors which affect the prognosis of MC.Methods: The clinical and follow-up data of 33 cases of MC patients treated in the second hospital of Hebei medical university from December2014 to December 2015 was collected and retrospectively analyzed.We also discussed the influence of age,gender,primary cancer,an interval from diagnosis of primary cancer to the diagnosis of MC,presence of brain parenchymal metastasis,intracranial pressure,protein,glucose,vascular endothelial growth factor(VEGF)level,eastern cooperative oncology group(ECOG)performance status(PS),systemic treatment and intrathecal chemotherapy on the prognosis of patients.Results:1 A total of 33 cases were enrolled,including 9 male and 24 female,with the median age of 55.50.The primary cancer were lung cancer which was the most common in 24,breast cancer in 2,gastric cancer in 2,unknown cancer in2,parotid gland carcinoma in 1,pancreatic cancer in 1,ovarian cancer in 1.The symptom of MC was the initial symptom in 14 cases without history of tumor.The main clinical symptoms were presented as manifestation of high intracranial pressure in 30 patients,spinal cord or spinal nerve injury in 13 patients,cranial nerve injury in 10 patients,epilepsy in 9 patients,consciousness disorders in 8 patients,and cognitive impairment in 1 patient.After admission,cerebrospinal fluid cytology examination showed the tumor cells for the first time in 30 cases.Magnetic resonance imaging(MRI)showed brain parenchymal metastasis in 13 cases out of 28.MRI with gadolinium enhancement showed intracranial abnormal strenthening signal of brain parenchyma or meninges in 5 cases out of 14.2 In the 33 patients,14 patients received standard intrathecal chemotherapy,tumor cells were not found in cerebrospinal fluid in 7 patients by cytology examination,and the incidence rate was 50%.The clinical symptomatic remissions of the group of intrathecal chemotherapy were complete remission in 4 cases,partial in 6,steady in 3,and progress in 1,and the control group were partial remission in 3,steady in 8,and progress in 8.The remission rate of the group of intrathecal chemotherapy was71.4%,and that of the control was 15.7%,the difference was statistically significant(P =0.003).The stability rate of the group of intrathecal chemotherapy was 92.8%,and that of the control group was 57.8%,the difference was statistically significant(P =0.047).3 As of 1 February 2016,30 patients were followed up,12 patients were still alive.The median survival time was 5.200 months(95% CI 0.000-11.491)and the survival rate of 3,6,12 months were respectively 71.6%,49.2%,30.7%.Univariate analysis showed that presence of brain parenchymal metastasis(P =0.014),ECOG PS(P =0.002)and intrathecal chemotherapy(P=0.001)were correlated with prognosis of patients.Multivariate analysis showed that intrathecal chemotherapy is an independent influential factors.Conclusion:1 MC are more common in middle-aged and elderly people,primary cancer commonly originate from lung cancer.The clinical symptoms are various and lack of specificity.Cerebrospinal fluid cytology is the gold standard for the diagnosis of MC,MRI without and with gadolinium enhancement can be helpful.2 Intrathecal chemotherapy can relieve the symptoms and extend life expectancy and early treatment can improve prognosis,so clinicians should actively adopt this method in the treatment of MC.3 Presence of brain parenchymal metastasis,ECOG PS and intrathecal chemotherapy are correlated with prognosis of patients,but intrathecal chemotherapy is an independent influential factors. |
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