原发性中枢神经系统淋巴瘤的高剂量MTX化疗加放疗——附17例临床疗效分析  

High-dose Methotrexate Chemotherapy and Radiotherapy for Primary Central Nervous System Lymphoma: Analyses for Treatment Outcome of 17 cases

作　　者：刘秀芳[1] 夏云飞[1] 黄慧强[2] 林旭滨[2] 张玉晶[1] 李勇[3] 

机构地区：[1]中山大学肿瘤防治中心放疗科,广东广州510060 [2]中山大学肿瘤防治中心内科,广东广州510060 [3]中山大学肿瘤防治中心内科,广东广州510060

出　　处：《中国神经肿瘤杂志》2004年第2期92-95,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景和目的:原发性中枢神经系统淋巴瘤(Primary central nervous system lymphoma,PCNSL)是一种罕见的原发并局限于脑和脊髓的非霍奇金氏淋巴瘤,治疗上主要采用高剂量MTX(HD-MTX)为主的化疗及放射治疗。本文探讨HD-MTX为主的化疗及放疗对PCNSL的疗效及毒性。方法:回顾性分析1991～2004年间我院收治的17例PCNSL患者的临床资料。其中,单纯CHOP方案化疗2例,含HD-MTX方案化疗12例,MTX/Ara-C/DXM鞘内注射9例。13例患者接受放射治疗。其中,单纯全脑放疗2例,全脑+局部缩野照射8例,全中枢放疗2例;侵犯野照射1例。结果:随访时间最长120个月,中位随访时间24个月。死亡4例,2例死于肿瘤进展,1例死于复发,1例死于放化疗后感染。结论:含HD-MTX为主的化疗联合全脑照射是PCNSL治疗的主要模式,治疗毒性可以耐受。放疗在PCNSL治疗中的地位有待进一步研究。BACKGROUND & OBJECTIVE: Primary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin's lymphoma, which originates from and limited in the central nervous system. Patients with PCNSL are usually treated by high-dose methotrexate-containing regimen in combination with radiotherapy. The purpose of this study is to evaluate the efficacy and toxicity of HD-MTX containing regimen chemotherapy combined with radiotherapy in the treatment of PCNSL. METHODS: Seventeen assessable patients with PCNSL treated from Jan 1991 to May 2004 were analyzed retrospectively. Two patients received CHOP regimen; Twelve patients received high-dose methotrexate containing regimen; Nine patients received intrathecal chemotherapy. Thirteen of 17 patients received radiotherapy. Among these, Two cases had whole brain irradiation alone. Eight cases had whole brain irradiation followed boost to tumor bed. Two cases had whole central nervous system irradiation. One case had invasive field irradiation alone. RESULTS: The median follow-up time was 24 months. Four cases died of recurrent PCNSL, tumor progression or infection. CONCLUSIONS: High-dose methotrexate-containing regimen combined with radiotherapy is the main modality to treat PCNSL. Toxicity is acceptable. The value of radiotherapy in the treatment of PCNSL is stilled to be investigated.

关 键 词：原发性中枢神经系统淋巴瘤 高剂量 MTX 化疗 放疗 

分 类 号：R739.4[医药卫生—肿瘤]