伽玛刀挽救性治疗原发性中枢神经系统淋巴瘤的疗效分析

Gamma Knife Radiosurgery in the Salvage Treatment of Recurrent Primary Central Nervous System Lymphoma

目的评估伽玛刀挽救性治疗原发性中枢神经系统淋巴瘤(PCNSL)的疗效。方法 23例病理证实为PCNSL的患者,经过以大剂量甲氨蝶呤(MTX)为基础的联合化疗后复发,采用伽玛刀治疗,进行回顾性分析。结果 23例患者,54处肿瘤接受了伽马刀治疗,所有病例接受了以甲氨蝶呤为基础的化疗。伽玛刀治疗情况:平均周边剂量14.4 Gy(11~18 Gy),平均等剂量曲线51.2%(50%~60%)。随访6~54个月,伽玛刀后6个月时评估:完全缓解(complete remission,CR)11例,部分缓解(partial remission,PR)7例,疾病稳定(stable disease,SD)2例,疾病进展(progressive disease,PD)1例。客观缓解率为85.7%。至随访结束时,23例患者中死亡6例,有4例患者肿瘤复发,接受化疗。中位无进展生存期(progression-free survival,PFS)9.5个月。结论伽玛刀挽救性治疗原发性中枢神经系统淋巴瘤痛苦小,安全有效,为大剂量甲氨蝶呤(MTX)为基础的联合化疗后复发患者重要的挽救性治疗方法。

Objective We aim to determine the effectiveness of Gamma Knife radiosurgery(GKRS) in the salvage treatment of recurrent PCNSL.Methods We reviewed and analyzed the clinical records for 23 patients diagnosed with PCNSL after histological confirmation by either stereotactic or open brain biopsy.All had received gamma knife radiosurgery after combined chemotherapy with high dose methotrexate(MTX).Results Twenty three patients(54 tumors) underwent GKRS.The mean prescription radiation dose was 14.4 Gy(range,11~18 Gy),and the mean prescription isodose configuration was 51.2%(range,50%~60%).A median follow-up was 11 months(range,6~54 months).Six months after gamma knife assessed:11 cases of complete remission(CR),7 cases of partial remission(PR),2 cases of stable disease(SD),and 1 case of disease progression(PD).The objective response rate was 85.7%.Six patients died and 17 patients survived at the end of the following-up and the median overall survival after GKRS was 9.5 months.Four patients had tumor recurrence and received chemotherapy.No significant side effects related to GKRS were observed.Conclusion Gamma Knife radiosurgery for patients with recurrent PCNSL is well tolerated and has a high rate of radiographic response.It may be beneficial as an important salvage therapy in the treatment of recurrent PCNSL patients after high-dose MTX-based combination chemotherapy.