大剂量甲氨蝶呤结合放疗治疗原发性中枢神经系统淋巴瘤  

High Dose of Methotrexate Combined with Cranial Irradiation for Primary Central Nervous System Lymphoma

作　　者：刘辉[1] 杨学军[1] 钟跃[1] 

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《天津医药》2010年第6期467-469,共3页Tianjin Medical Journal

摘　　要：目的:探讨化疗、放疗综合治疗原发性中枢神经系统淋巴瘤(PCNSL)的效果。方法:无免疫功能缺陷PCNSL患者39例,CT及MRI检查示单一病灶24例,病灶≥2个15例;41个病灶位于脑深部结构,18个病灶位于表浅部位。手术标本病理诊断为非霍奇金弥漫大B细胞淋巴瘤。其中20例行全脑放疗(A组);19例行化疗及放疗(B组),先给予2个周期甲氨蝶呤(MTX,按体表面积3g/m2静脉滴注),化疗结束2周后行全脑放疗。治疗结束时判定疗效。结果:A组完全缓解13例,部分缓解3例,稳定2例,进展2例;患者无进展生存期中位数为10.5个月,中位生存期为12.5个月。B组完全缓解16例,部分缓解3例;患者无进展生存期中位数为28个月,中位生存期为37个月,2例出现晚期神经系统损伤。B组治疗效果优于A组(Zc=2.629,P<0.05)。B组生存期长于A组(Zc=1.815,P<0.05),2组生存曲线差别有统计学意义(Log-rankχ2=14.627,P<0.05)。A组和B组分别有15例和7例复发,差别有统计学意义(χ2=5.77,P<0.05)。结论:大剂量MTX与放疗结合是治疗PCNSL的一种有效的方法。Objective： To investigate the effect of chemotherapy plus cranial irradiation in newly diagnosed patients with primary central nervous system lymphoma （PCNSL）. Methods： Thirty-nine PCNSL patients without immune deficiency were enrolled in this study. All patients were detected with CT and MRI. It was showed the solitary lesion in 24 patients and multiple lesions in 15 patients. Forty-one lesions were located in the deep cerebral structures, and eighteen lesions were superficial. Histological examination of the surgical specimen found PCNSL in all patients. Twenty patients（group A） received whole-brain radiotherapy （RT）. Nineteen patients （group B） received two cycles of methotrexate （MTX） 3 g/m2 first,then whole-brain RT. Results： The median progression-free survival was 10.5 months and overall survival was 12.5 months in patients of group A. Thirteen patients had a complete response and 3 patients had a partial response. The median progression-free survival was 28 months and overall survival was 37 months in patients of group B. Sixteen patients had a complete response and 3 had a partial response. Two patients experienced delayed neurologic toxicity. The patients in group B had better results than those in group A. Conclusion： High-dose MTX combined with cranial irradiation is an effective therapeutic approach for PCNSL.

关 键 词：甲氨蝶呤 中枢神经系统肿瘤 淋巴瘤 非霍奇金 放射疗法 

分 类 号：R739.4[医药卫生—肿瘤]