大剂量甲氨蝶呤联合放疗治疗19例原发性中枢神经系统淋巴瘤的临床观察

Clinical observation of the combination of high-dose methotrexate with radiotherapy in 19 patients with primary central nervous system lymphoma

目的观察大剂量甲氨喋呤联合放疗治疗原发性中枢神经系统淋巴瘤的疗效。方法2003年1月至2008年2月我院经手术或立体定向活检病理证实的19例原发性中枢神经系统淋巴瘤患者,予大剂量甲氨蝶呤化疗5～8个周期及阿糖胞苷+地塞米松鞘内注射12～16次,序贯全脑放疗30Gy,缩野10Gy。结果19例患者中位生存期为44个月,预计5年生存率为28.6%。毒副作用以骨髓抑制(100%)及胃肠道反应(77%)多见,其次为肝肾功能损害、口腔炎及脱发等。毒副反应多数可耐受。结论大剂量甲氨蝶呤化疗及阿糖胞苷+地塞米松鞘内注射序贯放疗治疗原发性中枢神经系统淋巴瘤的疗效满意,安全性好。

Objective To explore a better therapeutic regimen for primary central nervous system malignant lymphoma.Methods The diagnosis was confirmed by pathology in all the subjects.19 patients received high-dose methotrexate for 5-8 chemotherapy cycles and cytarabine with dexamethasone 12-16 times for intrathecal injection.Radiotherapy was carried out following chemotherapy.Results The Median survival were 44 months.The estimated 5-year OS was 28.6%.The most common side effects were myelosuppression（100%）and gastrointestinal tract disorders（77%）,after those were liver and（or）kidney functions abnormality,stomatitis and alopecia.The side effects were endurable.Conclusion Intravenous injection of high-dose methotrexate associating with intrathecal injection of cytarabine and dexamethasone followed by radiotherapy is a good remedy for primary central nervous system lymphoma.