非霍奇金淋巴瘤中枢神经系统侵犯的治疗

Whole Central Nerve System Irradiation and Chemotherapy in Secondary Central Nerve System Lymphomas

目的:研究化疗+全脑全脊髓放疗治疗非霍奇金淋巴瘤(NHL)中枢神经系统(CNS)侵犯的临床疗效.方法:回顾性分析18例合并中枢神经系统侵犯的非霍奇金淋巴瘤患者(15例为系统治疗后复发,3例为首程治疗前合并发生)的治疗情况,总结全脑全脊髓放疗治疗中枢神经系统侵犯的临床疗效.结果:326例病理诊断的NHL患者18例继发CNS侵犯,继发CNS侵犯多发生于B细胞性侵袭性淋巴瘤.经采用包括全脑全脊髓放疗在内的综合治疗,有效率77.8%(14/18),症状缓解率88.9%(16/18).发生CNS侵犯的中位时间为诊断NHL后11.5月(0～40月);发生CNS侵犯后中位生存时间为9月(3～36月);诊断NHL后总生存中位生存时间为19.5月(3～74月).发生CNS侵犯后1年生存率为45.1%,患者5年生存率为36.7%.未增加治疗相关死亡和毒性.结论:全脑全脊髓放疗是治疗非霍奇金淋巴瘤中枢神经系统侵犯的有效方法.

Objective： To study the efficacy of combined therapy with whole central nerve system （CNS） irradiation, involved field irradiation and systemic chemotherapy in the treatment of the secondary CNS lympboma. Methods. The clinical records of 18 patients with CNS involvement of nonHodgkin＇s lympbomas from Jan 1990 to Aug 2002 was reviewed. This cohort of patients were treated with two cycles CHOP regime chemotherapy followed by involved-field irradiation include whole-CNS irradiation followed by CHOP regime systemic chemotherapy. The efficiency of whole-CNS irradiation for CNS involvement lymphoma was analyzed. Results： The incidence of CNS involvement in B cell lymphoma more than in T cell lymphoma. The efficiency rate （complete response and partial response for the treatment） was 77.8% （14/18）. CNS involvement occurred after 11.5 months （ranging from 0 to 40 months）. The median survive was 9 months （ranging from 3 to 36 months）. The one-year survive rate was 45.1% and the overall five-years survive rate was 36.7 %. Conclusion： The whole-CNS irradiation is an effective method for the treatment of secondary CNS lymphoma.