29例原发性中枢神经系统淋巴瘤的诊断与治疗

Diagnosis and treatment of 29 cases with primary central nervous system lymphoma

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的诊断、治疗及效果。方法收治29例经病理证实的PCNSL患者,根据治疗方法的不同分为3组:6例患者肿瘤切除范围较小(包括2例活检),因颅高压不能承受进一步的治疗;7例术后接受放疗;16例术后接受放疗+化疗的综合治疗。出院后皆随访。结果单纯手术治疗者平均生存时间3.20个月,手术+放疗和手术+放疗+化疗者平均生存时间分别为32及40个月,综合治疗效果显著提高(P<0.05)。结论单纯手术不能有效控制PCNSL的发展,术后及时辅以放疗和(或)化疗可显著延长患者的生存时间。手术应以充分降低颅内压为目的,使患者能承受进一步的放疗和化疗。

Objective To explore the diagnosis, treatment and efficacies of primary central nervous system lyrnphoma （PCNSL）. Methods A total of 29 patients pathologically diagnosed as PCNSL were assigned into three groups according to the differences in therapeutic approaches： 6 cases with comparatively small extent of tumor resection （including 2 cases diagnosed by biopsy） could not receive further treatment due to intracranial hypertension; 7 cases received postoperative radiotherapy; 16 cases received the integrated postoperative treatment of radiotherapy ＋ chemotherapy. All the cases were followed up after discharge. Results The median survival time of patients who only received operations was 3.20 months, but that of the other two groups （operation ＋ radiotherapy and operation ＋ radiotherapy ＋ chemotherapy） were respectively 32 and 40 months. The therapeutic efficacies of the latter two groups were significantly higher （P〈0.05）. Conclusion Operations cannot effectively inhibit the progression of PCNSL alone; the assistant postoperative radiotherapy and （or） chemotherapy may evidently prolong the survival time of patients. Operations should be performed aiming at the sufficient degradation of intracranial pressure, so that patients may further endure radiotherapy and （or） chemotherapy.