İleri mide karsinomlu hastada baş ağrısı: Leptomeningeal Karsinomatoz

Öz

Solid organ tümörleri arasında Leptomeningeal karsinomatoz (LMC), metastatik meme kanserli hastalarda %12-35 oranıyla en sık görülendir. Tüm mide kanserlerinde LMC insidansı % 0.14-0.24 olarak bildirilmiştir ve seyrektir. Bizler metastatik mide kanseri için sistemik tedaviler alan ve baş ağrısı ile başvuran LMC'li bir hastayı sunduk. Dosetaksel-cisplatin-florourasil alan 27 yaşındaki metastatik mide kanseri ve peritonit karsinomatozlu hasta baş ağrısı ile başvurdu. Beyin MRG'sinde leptomeningeal tutulum görüldü ve beyin omurilik sıvısında (BOS) malign hücreler bulundu. İntratekal (IT) 12mg metotreksat (MTX) uygulandı. Hastanın IT'si devam ettirildi ve tedavi sonrası baş ağrısı şikayeti belirgin olarak azaldı. Sekiz haftalık IT MTX tedavisinden sonra, FOLFIRI rejimi başlatıldı. Üçüncü uygulamadan sonra acil servise kafa karışıklığı ile başvuran hasta LMC tanısından 15 hafta sonra hayatını kaybetti. Standart bir tedavi olmaksızın, LMC sağkalımı olumsuz etkileyen nadir bir durumdur. Yeni tedavi yaklaşımları oluşturmak ve sağkalımı uzatmak için bu alanda çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Leptomeningeal metastaz
• mide kanseri
• intratekal tedavi

Headache in a patient with advanced gastric carcinoma: Leptomeningeal Carcinomatosis

Abstract

Among the solid organ tumors, Leptomeningeal carcinomatosis (LMC) is most frequently seen with a rate of 12-35% in patients with metastatic breast cancer. In all gastric cancers, LMC incidence has been reported as 0.14–0.24%, and it is infrequent. Herein we presented a patient with LMC who received systemic treatments for metastatic gastric cancer and presented with headache. A 27-year-old patient with metastatic gastric cancer and peritonitis carcinomatosis, who received docetaxel-cisplatin-fluorouracil in first-line, presented with headache. leptomeningeal involvement was observed in the brain MRI, and malign cells were found in cerebrospinal fluid (CSF). Intrathecal (IT) 12mg methotrexate (MTX) was administered. The patient's IT continued, and the headache complaint decreased significantly after the treatment. After eight weeks of IT MTX treatment, a FOLFIRI regimen was initiated. After the third application, the patient, who was admitted to the emergency room with confusion, died 15 weeks after LMC's diagnosis. Without a standard treatment, LMC is a rare condition that negatively affects survival. Studies in this area are needed to establish new treatment approaches and to prolong survival.

Keywords

• leptomeningeal metastasis
• gastric cancer
• intrathecal therapy

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