伽玛刀联合替莫唑胺治疗原发中枢神经系统淋巴瘤的临床观察

Clinical efficacy of gamma knife combined with temozolomide in the treatment of primary central nervous system lymphoma

目的探讨伽玛刀(gamma knife)联合替莫唑胺(temozolomide,TMZ)放化疗治疗原发中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的疗效及安全性。方法选择2005-06—2016-10山东省安康医院收治的PCNSL患者48例为研究对象,随机分为2组各24例。对照组采用伽玛刀治疗,联合组在对照组治疗基础上应用TMZ联合治疗。比较2组患者治疗后近期疗效、生活质量及不良反应的发生情况及3 a内患者总生存率(response rate,RR)。结果联合组总生存率87.5%,对照组为54.17%,联合组显著高于对照组,差异有统计学意义(χ^2=4.941,P=0.026<0.05);联合组Karofsky得分(Karnofsky performance status score,KPS)改善率(62.50%)显著高于对照组(33.33%)(χ^2=4.090,P=0.043<0.05);2组恶心呕吐、头痛、白细胞减少、血小板减少和急性脑损伤等不良反应发生率差异均无统计学意义(P>0.05);随访3 a,联合组中位生存时间(median overall survival,mOS)24个月,显著长于对照组的15.5个月,差异有统计学意义(P=0.007)。结论伽玛刀联合TMZ可有效改善PCNSL患者的近远期疗效,具有良好的安全性,且可提高患者的生存质量。

Objective To investigate the efficacy and safety of gamma knife combined with temozolomide(TMZ)radiochemotherapy in the treatment of primary central nervous system lymphoma(PCNSL).Methods From June 2005 to October 2016,48 patients with PCNSL admitted to Ankang Hospital of Shandong Province were selected as the research subjects,and randomly divided into 2 groups of 24 patients.The control group was treated with gamma knife,and the combination group was treated with TMZ on the basis of the control group.The short-term curative effect,quality of life,the incidence of adverse reactions and the overall survival rate(response rate,RR)within 3 years were compared between the two groups.Results The overall survival rate of the combined group was 87.5%,and the control group was 54.17%.The combined group was significantly higher than the control group,the difference was statistically significant(χ^2=4.941,P=0.026<0.05);the Karofsky score of the combined group(Karnofsky performance status score,KPS)improvement rate(62.50%)was significantly higher than the control group(33.33%)(χ^2=4.090,P=0.043<0.05);the incidence of adverse reactions such as nausea and vomiting,headache,leukopenia,thrombocytopenia and acute brain injury in 2 groups was not statistically significant(P>0.05);after 3 years of follow-up,the median overall survival(mOS)of the combined group was 24 months,which was significantly longer than that of the control group of 15.5 months.The difference was statistically significant(P=0.007).Conclusion Gamma knife combined with TMZ can effectively improve the short-term and long-term efficacy of PCNSL patients,has good safety,and can improve the quality of life of patients.