転移性脳腫瘍の治療

―積極的治療方針に基づく成績―

抄録

Results of the treatment of multiple modalities on 74 cases with metastatic brain tumors were reported. Hospital patients with malignant diseases were surveyed by the authors even before being refered, and the majority of the cases was detected in this way. Bronchogenic carcinoma was the most frequent primary tumor, and was found in 62% of the cases. In four cases, no neurological symptoms were manifested when CT scans disclosed the brain metastasis. The treatment consisted of removal of the brain metastasis through a craniotomy (nine cases), shunt operation (17 cases), radiotherapy (41 cases; whole brain and local, Linac), chemotherapy (46 cases), endocrine therapy (a few cases) and immunotherapy (a few cases). Adequate treatment was completed under betamethazone administration in 52 cases, but it was interrupted in another 14 cases, and no treatment was given in the remaining eight, mainly because of the deteriorated systemic dissemination. Out of 52 cases adequately treated, 43 (82%) showed a satisfactory remission in the neurological examination and/or CT scan following the treatment. Among them, 23 were discharged, but the others remained hospitalized for the metastases disseminated outside the central nervous system. The remaining nine still showed a progressive disease. Eventually, 49 expired 2 to 39 months after the onset of brain metastasis, while all of the insufficiently treated and untreated cases died within 5 months. Brain metastasis was the cause of death in 32.6% of the adequately treated, and 55.8% of the insufficiently treated and untreated cases. There are three surviving cases. The longest survivors were a female with breast cancer (removal, radiotherapy, endocrine therapy and chemotherapy), and a male with seminoma (radiotherapy), both remaining alive for more than 40 months. Calculated according to Kaplan and Meier, the 50% survival time was 6.8 months in the removal cases, 5.3 months in the non-surgically treated cases (p>0.5), and 0.9 months in the insufficiently treated and untreated cases (p<0.001). Autopsy was performed in 24 cases adequately treated, and revealed disappearance of the metastatic foci in the brain in seven cases, regressive changes of the tumor cells in the brain metastasis in nine, and proliferative tumors in six cases. In seven cases, meningeal carcinomatosis was complicated.