脑室播散型复发性胶质母细胞瘤放疗联合靶向治疗及免疫治疗后存活2.5年1例报道并文献复习  

Radiotherapy combined with targeted therapy and immunotherapy for ventricular disseminated recurrent glioblastoma surviving for 2.5 years:a case report and literature review

作　　者：郭晓鹏[1] 王裕[1] 马文斌[1] GUO Xiao-peng;WANG Yu;MA Wen-bin(Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科,北京100730

出　　处：《中国临床神经外科杂志》2024年第12期720-723,728,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脑室播散型复发性胶质母细胞瘤(GBM)的治疗方法及疗效。方法回顾性分析1例脑室播散型复发性GBM的临床资料,并结合相关文献进行总结分析。结果1例57岁男性,因右侧颞枕叶占位,行开颅手术全切除病变,术后病理显示IDH野生型GBM(WHO分级4级),MGMT启动子非甲基化;术后给予标准Stupp方案治疗。术后1年复查MRI发现左侧脑室壁近室间孔处及透明隔结节样强化,考虑疾病进展,进行化疗5 d,因并发严重免疫抑制合并重症肺炎而停止化疗;4个月后复查MRI发现左侧尾状核头、胼胝体膝、透明隔结节样强化灶显著增大,对新发病灶行三维调强放疗;1个月复查MRI显示病变继续进展,双侧脑室及第四脑室软膜强化,考虑脑室播散。采用帕博利珠PD-1单抗和贝伐珠单抗治疗2个疗程,病灶完全消失。2年后,病人自行停用单抗治疗。停用半年复查MRI发现左侧脑室内广泛病灶,继续采用单抗治疗,但病变仍快速进展;1个月后复查MRI显示左侧侧脑室及第四脑室被强化的病灶完全填充,2个月后,病人死亡。结论本文病例总生存期超过4年,自脑室播散后总生存期维持约2.5年。这提示放疗+靶向+免疫的联合治疗方案可能成为复发性GBM病人的可选治疗方案之一。Objective To explore the treatment methods and efficacy of ventricular disseminated recurrent glioblastoma multiforme(GBM).Methods A retrospective analysis was conducted on the clinical data of a patient with ventricular disseminated recurrent GBM,and the relevant literature was summarized and analyzed.Results The patient was a 57-year-old male who underwent craniotomy for total resection of a right temporal-parietal lobe mass.The postoperative pathology showed IDH wild-type GBM(WHO grade 4)with unmethylated MGMT promoter.The patient received standard Stupp protocol treatment after surgery.One year after surgery,MRI showed nodular enhancement near the interventricular foramen and septum pellucidum on the left ventricular wall,suggesting disease progression.Five days of chemotherapy was administered,but it was stopped due to severe immunosuppression and severe pneumonia.Four months later,MRI showed significant enlargement of nodular enhancement in the left caudate nucleus,genu of the corpus callosum,and septum pellucidum.Three-dimensional intensity-modulated radiotherapy was performed on the new lesions.One month later,MRI showed continued disease progression with soft meningeal enhancement in both lateral ventricles and the fourth ventricle,indicating ventricular dissemination.Subsequently,two courses of combined treatment with pembrolizumab(PD-1 inhibitor)and bevacizumab were administered,and the lesions completely disappeared.Two years later,the patient stopped the monoclonal antibody treatment on his own.Six months after drug withdrawal,MRI showed extensive lesions in the left ventricle.Monoclonal antibody treatment was resumed,but the lesions still progressed rapidly.One month later,MRI showed that the left lateral ventricle and the fourth ventricle were completely filled with enhanced lesions.The patient died two months later.Conclusion The total survival period of this case exceeded 4 years,and the survival period after ventricular dissemination was approximately 2.5 years.This suggests that radiotherapy co

关 键 词：胶质母细胞瘤 脑室播散 靶向治疗 免疫治疗 放射治疗 

分 类 号：R739.41[医药卫生—肿瘤]