大剂量甲氨蝶呤治疗原发性中枢系统淋巴瘤疗效分析

Clinical efficacy of high-dose methotrexate chemotherapy for primary central nervous system lymphomas

目的分析北京天坛医院神经外科原发性中枢神经系统淋巴瘤（Primarycentralnervoussystemlymphoma，PCNSL）治疗现状，为国内神经外科PCNSL规范化治疗提供参考。方法回顾性分析2006年1月至2013年5月北京天坛医院收治活检病理确诊PCNSL后大剂量甲氨蝶呤治疗的65例患者，与2004年至2005年手术切除，或联合全脑放疗患者的中位生存期、无进展生存期、不良反应等进行比较、分析不同治疗方法的疗效。结果65例接受甲氨蝶呤化疗的PCNSL患者经过4～7个周期化疗后，CR61．5％（40／65），PR27．7％（18／65），总有效率89．2％，中位生存期60．6个月，无进展生存期39个月，化疗主要不良反应包括口腔溃疡、皮疹、恶心、呕吐、血小板减少等；14例全切或近全切肿瘤患者，中位生存期3．8个月；13例全切或近全切联合全脑放疗患者，中位生存期14个月（P〈0．01）。结论单纯的手术全切或近全切肿瘤并不能使PCNSL患者生存获益，联合大剂量甲氨蝶呤化疗可以改善患者生存期，是目前PCNSL一线治疗方案。

Objective To provide reference for the development of standard treatment protocols for primary central nervous system lym- phomas （PCNSL） for Chinese neurosurgeons by performing an analysis of treatment status of PCNSL at Beijing Tiantan Hospital. Methods We retrospectively reviewed 65 patients with histologically proven PCNSL who were treated with high-dose methotrexate （MTX） from January 2006 to May 2013 at Beijing Tiantan Hospital, and compared them with PCNSL patients who received surgical re- section alone or in combination with whole brain radiotherapy from 2004 to 2005 at the same hospital in terms of median overall surviv- al, progression-free survival, and adverse reactions. Results After 4 to 7 cycles of chemotherapy with MTX, the overall response rate of the 65 cases of PCNSL was 89.2% [ complete response （CR） 61.5%, partial response （PR） 27.7% ]. The median overall surviv- al for the cohort was 60.6 months and the progression-free survival was 39 months. The main adverse reactions induced by chemothera- py with methotrexate were oral ulcer, rash, nausea, vomiting, and thrombocytopenia. The median overall survival was 3.8 months in 14 patients with gross total resection or subtotal resection, and 14 months in 13 patients with gross total resection or subtotal resection followed by whole brain radiotherapy （P 〈 0.01 ）. Conclusions Complete resection or subtotal resection alone does not provide surviv- al benefit for patients with PCNSL. High-dose MTX can improve survival and is still the first-line treatment for PCNSL.