减量放疗治疗大剂量甲氨蝶呤化疗后短期内失败的原发性中枢神经系统淋巴瘤效果探讨  

Low dose whole-brain radiotherapy on patients unresponsive to high dose methotrexate chomotherapy in short term failure for primary central nervous system lymphoma

作　　者：高洪元[1] 汪洋[1] 吴学勇[1] 盛晓芳[1] 张玺炜[1] 殷晓峰[1] 倪春霞[2] 孟歌[2] 

机构地区：[1]上海市静安区中心医院肿瘤科,上海200040 [2]复旦大学附属华山医院上海伽玛医院放疗中心,上海200235

出　　处：《上海预防医学》2016年第2期113-117,共5页Shanghai Journal of Preventive Medicine

摘　　要：目的 本研究采用低剂量全脑放疗联合残留病灶调强放疗作为挽救性方法,治疗以大剂量甲氨蝶呤（HD-MTX）为基础的联合化疗失败的难治性中枢神经系统淋巴瘤（PCNSL）,观察该方法的疗效和安全性。方法对16例以HD-MTX为基础的联合化疗短期内失败的PCNSL患者进行挽救性放疗,方案是：先采用低剂量全脑放疗（2 Gy/次,全脑照射剂量为24 Gy）,全脑放疗结束时以磁共振复查结果作初步评价,如有肿瘤残留,则行调强放疗局部补量（2 Gy/次,16～20 Gy）。记录治疗不良反应,对近期治疗效果进行评价,采用Kaplan-Meier方法测定患者无疾病进展生存率以及总生存率,分别采用卡氏评分和MMSE表评价患者治疗前后的生活质量和认知功能。结果2010年1月—2014年12月共16例患者入组。入组病例急性不良反应多为Ⅰ～Ⅱ级,其中Ⅰ度消化道反应患者6例,Ⅰ度骨髓抑制患者5例,Ⅱ度消化道反应患者1例,无肝肾毒性反应,无Ⅲ级及以上不良反应。近期疗效评价：完全缓解7例（43.75%）,部分缓解9例（56.25%）,无变化病例和恶化病例均为0例;卡式评分提高15例,不变1例,下降0例。放疗结束1个月患者认知功能较放疗前略改善,放疗结束半年及1年时间点,患者的认知功能与放疗前相比无变化。至末次随访,9例患者出现疾病进展,13例患者死亡。本组6、12和24个月疾病无进展生存率分别为37.50%、6.25%和0.00%,中位疾病无进展生存时间为6个月;本组6、12和24个月总体生存率分别为93.75%、43.75%和12.50%,中位总生存时间为13个月。结论 采用低剂量全脑放疗联合残留病灶调强放疗挽救性治疗以HD-MTX为基础的联合化疗失败的难治性PCNSL,疗效较好,患者的认知能力和近期生活质量明显改善,不良反应轻微。Objective To investigate the efficacy and safety of low dose whole -brain radiotherapy combined with residual disease intensity-modulated radiotherapy on PCNSL patients. Methods A total of 16 patients, who were unresponsive to high dose methotrexate in short term, were treated with low dose whole-brain radiotherapy （24 Gy） combined with intensity-modulated radiotherapy （16Gy）. After radiotherapy, the follow-up data were collected. Results Grade I - Ⅱ of acute treatment toxicity was found, toxicity of more than Ⅲ was not observed. In all 16 cases, there were 7 cases for CR, 9 cases for PR, no cases for SD and PD. KPS were improved in 15 patients, and not change in 1 patient. And therewas no reduction of cognitive ability in these patients Progression free survival rates in 6, 12, and 24 months were 37.5%, 6.25% and O. 0%, respectively. The free survival time of median progression was 6.0 month. Overall survival rates in 6, 12, and 24 months were 93.75% , 43.75% and 12. 5% respectively. The survival time of total median was 13.0 month. Conclusion This study demonstrated that low dose whole-brain radiotherapy combined with residual disease intensity-modulated radiotherapy is effective and safe for PCNSL patients who were unreponsvie to high dose methotrexate in short-term.

关 键 词：中枢神经系统恶性淋巴瘤 低剂量全脑放疗 局部调强放疗 疗效 

分 类 号：R739.41[医药卫生—肿瘤]