吉非替尼联合脑室腹腔分流治疗以恶性颅内高压为初发症状的肺腺癌脑膜转移患者的疗效  

Effectiveness of gefitinib in combination with ventriculoperitoneal shunt on leptomeningeal metastases of lung adenocarcinoma with malignant cranial pressure as incipient symptom

作　　者：石颜慧 仓顺东[1] 栗超跃[2] 赵黎明[2] 李永丽[3] 韩倩[4] 魏立[5] 

机构地区：[1]郑州大学人民医院肿瘤内科,河南郑州450003 [2]郑州大学人民医院神经外科,河南郑州450003 [3]郑州大学人民医院放射科,河南郑州450003 [4]郑州大学人民医院放疗科,河南郑州450003 [5]郑州大学人民医院胸外科,河南郑州450003

出　　处：《肿瘤》2017年第1期72-76,共5页Tumor

摘　　要：目的 :探讨脑室腹腔分流手术治疗恶性颅内高压为初发症状的肺腺癌脑膜转移的临床效果。方法 :回顾性分析本院收治的21例表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变的肺腺癌脑膜转移患者的临床资料,根据治疗方案将患者分为观察组(吉非替尼联合脑室腹腔分流组11例)和对照组(吉非替尼组10例),对2组的治疗效果进行比较。结果 :观察组的脑脊液癌细胞转阴率为63.6%,对照组的脑脊液癌细胞转阴率为40.0%,两组比较差异无统计学意义(P>0.05);观察组症状缓解率为90.9%,对照组症状缓解率为40.0%,两组比较差异有统计学意义(P<0.05);观察组的中位无进展生存期为7.8个月,对照组中位无进展生存期为5.3个月,两组比较差异有统计学意义(P=0.014)。结论 :以恶性颅内高压为初发症状的EGFR基因突变的肺腺癌脑膜转移患者接受吉非替尼联合脑室腹腔分流取得了较好的治疗效果,有望成为EGFR基因突变的肺腺癌脑膜转移患者的治疗方案。Objective To analyze the clinical effect of ventriculoperitoneal shunt in the treatment of leptomeningeal metastases of lung adenocarcinoma with malignant cranial pressure as incipient symptom. Methods： The clinical records of patients diagnosed of lung adenocarcinoma harboring epidermal growth factor receptor （EGFR） mutation with leptomeningeal metastases were collectedand retrospectively analyzed. The patients were divided into observation group （gefitinib combined with ventriculoperitoneal shunt group, n = 11） and the control group （gefitinib group, n = 1 O） according to the therapeutic regimens, and the curative effect of the cytologic conversion rate and the symptom remission rate of the two groups were analyzed. Results： The cytologic conversion rates of the observation group and the control group were 63.6% and 40.0%, respectively, and the difference was not statistically significant （P 〉 0.05）; the symptom remission rates of the observation group and the control group were 90.9% and 40.0%, respectively, and the difference was statistically significant （P 〈 0.05）; the median progression-free survival time of the observation group and the control group were 7.8 months and 5.3 months, respectively, and the difference was statistically significant （P = 0.014）. Conclusion： Gefitinib combined with ventriculoperitoneal shunt can effectively improve the curative effect of leptomeningeal metastases of lung adenocarcinoma harboring EGFR mutation with malignant cranial pressure as incipient symptom. EGFR-tyrosine kinase inhibitor （EGFR-TKi） combined with ventriculoperitoneal shunt may be the optimal strategy for leptomeningeal metastases with EGFR mutation, especially in patients with malignant cranial pressure as incipient symptom.

关 键 词：肺腺癌 脑膜转移 颅内高压 脑室腹膜分流术 吉非替尼 

分 类 号：R734.2[医药卫生—肿瘤]