原发性中枢神经系统淋巴瘤复发或进展模式的回顾性、单中心分析:是否可以替换全脑放疗?  

A single-center,retrospective analysis of relapse and progression patterns of primary central nervous system lymphoma:can whole brain radiotherapy be replaced?

作　　者：秦悦 刘蓉萍 张效楠 张湾[1] 任陈[1] 吴德华[1] QIN Yue;LIU Rongping;ZHANG Xiaonan;ZHANGWan;REN Chen;WU Dehua(Department of Radiation Oncology,Nanfang Hospital,Southern Medical University,Guangzhou,510515,China;Department of Radiation Oncology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]南方医科大学南方医院放疗科,广东广州510515 [2]中山大学肿瘤防治中心放疗科,广东广州510060

出　　处：《南方医科大学学报》2023年第4期499-506,共8页Journal of Southern Medical University

基　　金：国家自然科学基金(81972970);广州市科技计划项目(202201011116)。

摘　　要：目的回顾我院未经全脑放疗(WBRT)治疗的原发性中枢性淋巴瘤(PCNSL)患者的复发/进展模式,评估WBRT在PCNSL治疗中的作用。方法采用回顾性单中心研究,确定了27例符合纳入标准的PCNSL患者。通过比较患者初诊时和复发/进展时强化病灶的解剖位置,分析不同治疗反应和不同病灶初始状态患者的复发/进展模式。结果基于MRI影像学资料对PCNSL患者化疗后复发模式的探索性分析显示,16例(16/27,59.26%)患者复发/进展部位为野外但在WBRT靶区内,11例(11/27,40.74%)患者的复发/进展部位为野内;所有患者均未出现颅外播散。在未经WBRT但初治后达到完全缓解(CR)的11例患者中,9例(81.82%)复发位于野外但在WBRT靶区内。在13例单个初始病灶的患者中,11例(84.62%)复发/进展出现在野外但在WBRT靶区内。结论全身治疗联合WBRT仍是PCNSL患者的治疗标准,尤其是对于治疗后达到CR或只有单一初始病灶的患者。有必要进行更大样本的前瞻性研究,进一步探讨低剂量WBRT在PCNSL治疗中的作用。Objective To analyze recurrence and progression patterns of primary central nervous system lymphoma(PCNSL)in patients without whole brain radiotherapy(WBRT)and assess the value of WBRT in PCNSL treatment.Methods This retrospective single-center study included 27 patients with PCNSL,who experienced recurrence/progression after achieving complete remission(CR),partial remission,or stable disease following initial treatments with chemotherapy but without WBRT.The patients were followed up regularly after the treatment for treatment efficacy assessment.By comparing the anatomical location of the lesions on magnetic resonance images(MRI)at the initial diagnosis and at recurrence/progression,we analyzed the patterns of relapse/progression in patients with different treatment responses and different initial status of the lesions.Results MRI data showed that in 16(59.26%)of the 27 patients,recurrence/progression occurred in out-field area(outside the simulated clinical target volume[CTV])but within the simulated WBRT target area in 16(59.26%)patients,and within the CTV(in-field)in 11(40.74%)patients.None of the patients had extracranial recurrence of the tumor.Of the 11 patients who achieved CR after the initial treatments,9(81.82%)had PCNSL recurrences in the out-field area but within WBRT target area;of the 13 patients with a single lesion at the initial treatment,11(84.62%)experienced PCNSL recurrence in the out-field area but within WBRT target area.Conclusions Systemic therapy combined with WBRT still remains the standard treatment for PCNSL patients,especially those who achieve CR after treatment or have a single initial lesion.Future prospective studies with larger sample sizes are needed to further explore the role of low-dose WBRTin PCNSLtreatment.

关 键 词：原发性中枢神经系统淋巴瘤 放射治疗 全脑放疗 复发/进展模式 

分 类 号：R739.41[医药卫生—肿瘤]