经Ommaya囊脑室内注射培美曲塞治疗非小细胞肺癌软脑膜转移1例及文献回顾  

Use of Ommaya Reservoirs to Deliver Pemetrexed in Leptomeningeal Metastasis from Non-small Cell Lung Cancer: A Case Report and Review of the Literature

作　　者：林永娟[1] 李会颖 黄明敏[1] 郭爱斌[1] 尹震宇[1] Yongjuan LIN;Huiying LI;Mingmin HUANG;Aibin GUO;Zhenyu YIN(Department of Geriatric Oncology,Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院老年肿瘤科

出　　处：《中国肺癌杂志》2019年第8期546-550,共5页Chinese Journal of Lung Cancer

基　　金：南京市卫生局重点项目（No.ZKX16031）;南京市科学技术委员会医疗卫生项目（No.201715020）;南京市医学重点科技发展项目（No.ZKX18014）;江苏省干部保健科研课题（No.BJ18006）;希思科-豪森肿瘤研究基金（No.Y-HS2019-5）资助~~

摘　　要：软脑膜转移(leptomeningeal metastasis, LM)是非小细胞肺癌(non-small cell lung cancer, NSCLC)最严重的并发症之一。随着靶向药物的发展,LM发病率逐年上升,目前缺乏标准有效的治疗方案。鞘内化疗是治疗LM的一种重要方法,但对于NSCLC伴LM,现有的经鞘内途径给化疗药物治疗效果有限,最佳的药物、给药途径、给药模式和剂量仍不清楚。本文报道1例NSCLC伴LM患者,经奥希替尼治疗病情进展后,予培美曲塞经Ommaya囊脑室内化疗,颅内病灶得到较好控制,脑脊液(cerebrospinal fluid, CSF)细胞学转为阴性,同时患者耐受良好,生活质量明显改善,病情长时间内维持稳定,从确诊LM后随访至今已17个月。本文报道了国内外第一例关于经Ommaya囊鞘内注射培美曲塞治疗NSCLC患者LM的临床案例,并结合相关文献总结了鞘内化疗的安全性及有效性,为临床提供了一种LM局部治疗的新策略。Leptomeningeal metastasis(LM) is one of the most severe complications of non-small-cell lung cancer(NSCLC), and its incidence is increasing gradually with the progress of targeted therapies. There are currently no standard guidelines for the therapy of LM. Intrathecal chemotherapy is the mainstay of treatment for NSCLC patients with LM, but the optimal drug, administration route and mode, and dosage remain unclear. We report a case of LM from NSCLC, who received the intrathecal chemotherapy with pemetrexed by Ommaya reservoir after prior targeted therapies. This local treatment improved the quality of life, and obtained the clearing of CSF cytology and stable lesions of LM without any notable side effects. After confirmation of LM, the patient has survived 17 months until now. Here we report the first case to demonstrate the potential effectiveness of intrathecal pemetrexed by Ommaya reservoir for the treatment of LM of NSCLC, summarize the safety and effectiveness of intrathecal chemotherapy in combination with related literatures, and provide a new strategy for local treatment of LM in clinical.

关 键 词：肺肿瘤 软脑膜转移 OMMAYA囊 培美曲塞 

分 类 号：R734.2[医药卫生—肿瘤]