立体定向放射手术结合化疗治疗原发性中枢神经系统淋巴瘤

Stereotactic radiosurgery combined with chemotherapy for primary central nervous system lymphoma

目的评价伽玛刀立体定向放射手术(GKR)结合化疗治疗原发性中枢神经系统淋巴瘤(PCNSL)的临床疗效。方法分析1995～2002年48例经病理证实的PCNSL,病人随机分为治疗组23例,对照组25例,各组均应用GKR治疗,治疗组加用威猛(VM-26)+甲基环乙亚硝脲(MeCCNU)、大剂量氨甲喋呤(MTX)、化疗。结果两组近期疗效完全缓解39例,部分缓解5例,近期有效率为100%。Karnofsky评分迅速由术前的平均50%上升为术后的平均80%。治疗组局控率及生存率高于对照组,有显著性差异。结论伽玛刀结合化疗治疗PCNSL是一种安全、有效的治疗方法,也是综合治疗PCNSL方案中最有效的方案之一。

Objective To evaluate the clinical efficacy for the patients with primary central nervous system lymphoma (PCNSL) treated by gamma knife radiosurgery(GKR) combined with chemotherapy. Methods From Jan. 1995 to Dec. 2002, forty-eight cases of PCNSL confirmed by pathological examination were randomly divided into therapy group (n1 = 23) and control group (n2 = 25). They were all treated with GKR. The patients in therapy group received chemotherapy with various regimens of VM-26+MeCCNU and high-dose MTX. Results The results in short term showed that CR were in 39 patients and PR in 5 patients. The effective rate in two groups was 100%. Kamofsky scale was also improved from 50% preoperatively to 80% postoperatively. The patients in therapy group had a significantly longer period of local tumor growth control rate and survival rate than those in control group. Conclusion GKR combined with chemotherapy is a safe and effective method for PCNSL, and also is one of the most effective therapeutic modalities in multimodality treatment of PCNSL.