진행성 위암으로부터의 뇌전이: 연수막 전이가 생존에 미치는 영향

• 영문명: Brain metastasis from advanced gastric cancers: Leptomeningeal metastasis and its clinical impact on survival
• 발행기관: 대한두개저학회
• 저자명: 이서윤(Seoyun Lee) 김의현(Eui Hyun Kim)
• 간행물 정보: 『대한두개저학회지』제19권 제2호, 93~102쪽, 전체 10쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2024.10.31

국문 초록

Background: Gastric cancer is one of the most common and fatal cancers worldwide, however, brain metastasis from gastric cancer is very rare. Leptomeningeal metastasis (LMM) is well known for its devastating prognosis and mortality, critical cause that leads patients diagnosed with brain metastasis to death. Therefore, to improve overall survival of patients with brain metastasis from gastric cancer, LMM in gastric cancer should be essentially dealt with. Materials and Methods: We reviewed our 128 patients diagnosed with gastric cancer with brain metastasis. We identified 74 patients presented evidences of LMM. We evaluated whether patient characteristics, treatment modalities determine survival outcome both in the group of entire 128 patients and in the group of 72 patients with LMM. Results: Overall survival of LMM group was significantly shorter than that of non-LMM group. Among LMM group, overall survival of pure LMM group with no parenchymal metastasis was significantly shorter than that of non-pure LMM group with parenchymal metastasis. On all 128 patients, those treated with tumor removal followed by whole brain radiotherapy (WBRT) showed superior overall survival than WBRT alone. On 74 LMM patients, those who underwent WBRT combined with intrathecal methotrexate showed better outcome than WBRT only. Specifically, on 51 pure LMM patients, same trend was reported, and the former treatment showed better outcome than the latter. Conclusions: Targeting LMM rather than parenchymal metastasis will be more critical. we should continue searching for the best strategy and key regimens that can significantly target LMM, maximizing the therapeutic effect and minimizing neurotoxicity.

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키워드

Advanced gastric cancer Brain metastasis Intrathecal chemotherapy Leptomeningeal metastasis Whole brain radiotherapy