利妥昔单抗联合适形放疗治疗术后原发中枢神经系统淋巴瘤的疗效分析

Rituximab in combination with conformal radiotherapy treatment of postoperatiwe primary centralnervous system lymphoma

目的 探讨利妥昔单抗结合全颅放射治疗、局部三维适形放疗（3D-CRT）加量治疗术后原发中枢神经系统淋巴瘤（PCNSL）的疗效。方法PCNSL术后患者23例，年龄均〈60岁，全颅收射治疗处方剂量32．4Gy，局部病灶采用3D-CRT推加剂量至50．4Gy，放射治疗第1天开始使用利妥旨单抗（375mg／m^2），每周1次，连续使用6周。用Kaplan-Meier法分析患者的生存情况。结果23例患者中，完全缓解19例i82．6％），部分缓解3例（13．0％）；无进展生存14例（60．9％），无病生存期26个月（17-34个月），总生存期为40个月（29-55个月）；无Ⅲ-Ⅳ级神经毒性出现。结论利妥昔单抗联合全颅放疗、病灶部位3D-CRT推量的方案治疗年龄〈60岁的术后PCNSL患者可以获得较长的生存期，而且治疗的不良反应低。

Objective To analyze 1he long-term results of rituximab combined with whole brain radiotherapy and 3-dimentional conformal radiotherapy （3D-CRT） in treatment of patients with primary central nervous system lymphoma （PCNSL）. Methods 23 postoperative patients younger than 60 years old were treated. Whole brain radiotherapy with dose of 32.4 Gy were performed and lesions were followed by 3D-CRT with dose of 18 Gy. A dose of rituximab （375 mg/m^2） was infused on day 1 （once a week for six weeks）. The overall survival was analyzed by using Kaplan-Meier. Results 19 patients（82.6 %） was complete remission 3 patients （13.0 %） was part remission, 14 patients （60.9 %） was progression-free survival was 26 months （17-34 months）. The overall survival was 40 months （29-55 months）. Toxicity was moderate without grade 3-4 neurotoxicity toxic events. Conclusions Radiotherapy （whole brain radiotherapy with sequential 3D-CRT） combined with rituximab seems to yield substantial long-term survival with moderate toxicity for the treatment of the younger patients with PCNSL.