A phase Ⅱ trial of comprehensive treatment based on radiotherapy in leptomeningeal metastasis
10.3760/cma.j.cn113030-20200309-00094
- VernacularTitle:放疗为主的综合方案治疗脑膜转移瘤Ⅱ期临床研究
- Author:
Siran YANG
1
;
Qingfeng LIU
;
Jianping XIAO
;
Hongmei ZHANG
;
Nan BI
;
Ye ZHANG
;
Yuchao MA
;
Kai WANG
;
Xuesong CHEN
;
Ruizhi ZHAO
;
Xi WU
;
Junling LI
;
Junlin YI
;
Shulian WANG
;
Yexiong LI
Author Information
1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科 100021
- From:
Chinese Journal of Radiation Oncology
2020;29(9):744-750
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of comprehensive treatment based on radiotherapy for patients with leptomeningeal metastases (LM) in this prospective study.Methods:A total of 93 patients diagnosed with LM admitted to our hospital undergoing whole brain radiotherapy (WBRT) or craniospinal irradiation (CSI) with or without simultaneous boost from 2014 to 2017 were enrolled. The dynamic changes of clinical signs and symptoms, enhanced magnetic resonance imaging (MRI), cerebrospinal fluid cytology and liquid biopsy detection were recorded. The primary endpoint was overall survival (OS), the secondary endpoints were local control (LC), intracranial progress-free survival (IPFS), brain metastasis specific survival (BMSS) and toxicity.Results:The major primary disease was non-small cell lung cancer. The whole cohort received WBRT with boost (40 Gy in 20 fractions (f) for WBRT and 60 Gy in 20 f for boost), focal radiation to LM, WBRT and CSI (40 Gy in 20 f or 50 Gy in 25 f for WBRT and 36 Gy in 20 f for CSI). For 20 patients, tumor cells were identified and intrathecal chemotherapy was performed. Sixty-three patients received target therapy. The median follow-up time was 33.8 months. The 1-year OS, LC and IPFS was 62.4%, 77.2% and 52.6%, respectively. The median survival time was 15.9 months, and the median BMSS was 42.2 months. Treatment-related grade 3-4 adverse events were rare and only 8 cases was observed to have grade 3 hematological toxicity.Conclusion:Reasonable comprehensive treatment including precise radiotherapy, intrathecal chemotherapy and targeted therapy can be well tolerated and prolong the survival time of LM patients.
