Pöttgen Christoph, Stuschke Martin, Stüben Georg, Schmitz Armin, Schwechheimer Karl, Wacker Hans-Heinrich, Rauhut Friedhelm, Kleuker Susanne, Wilhelm Hans, Grehl Sara, Fehlings Thorsten
Department of Radiotherapy, University Hospital Essen, Germany.
Strahlenther Onkol. 2003 Sep;179(9):626-32. doi: 10.1007/s00066-003-1083-3.
To analyze the long-term results following whole brain radiotherapy (WBRT) with sequential intrathecal (i.th.) cytosine arabinoside (Ara-C) +/- intravenous (i.v.) Ara-C in patients with primary central nervous system lymphoma (PCNSL).
14 patients were treated between July 1987 and August 1995. All had sporadic PCNSL with proven histology of high-grade CNS lymphoma (twelve diffuse large-cell B-lymphomas, one lymphoblastic lymphoma, one large T-cell lymphoma). Patients were treated with two to four cycles of induction chemotherapy (40 mg/m2 Ara-C i.th.), four patients received additional Ara-C i.v. (150 mg/m2, d1-4). WBRT was administered using 1.8-Gy fractions. Intrathecal chemotherapy was planned afterwards in 4-week intervals for 6 months. Posttreatment neurocognitive evaluations were performed in two long-term survivors.
Two of four patients who received i.v. and i.th. induction chemotherapy showed progressive disease, and irradiation was started immediately. Six of 14 patients received 50.4 Gy WBRT, four patients had WBRT up to 39.6 Gy followed by a 10.8-Gy boost. Five patients died early during therapy either due to a decline of the general medical condition or progressive disease. Median survival was 41 months (95% confidence interval: 6-79 months), survival at 3 and 5 years was 59% and 42%, respectively. Six patients survived for 3 years, two younger patients are still alive (> 12 years). They show only slightly impaired neurocognitive functions without clinical relevance.
This WBRT-based protocol with i.th. meningeal prophylaxis using Ara-C +/- i.v. Ara-C yields substantial long-term survival with moderate toxicity. The value of i.v. chemotherapy is currently being investigated in prospective studies.
分析原发性中枢神经系统淋巴瘤（PCNSL）患者接受全脑放疗（WBRT）联合鞘内注射阿糖胞苷（Ara-C）及静脉注射阿糖胞苷（Ara-C）或单纯鞘内注射阿糖胞苷后的长期疗效。
1987年7月至1995年8月期间对14例患者进行了治疗。所有患者均为散发性PCNSL，经组织学证实为高级别中枢神经系统淋巴瘤（12例弥漫性大B细胞淋巴瘤、1例淋巴母细胞淋巴瘤、1例大T细胞淋巴瘤）。患者接受了2至4个周期的诱导化疗（鞘内注射阿糖胞苷40mg/m²），4例患者还接受了静脉注射阿糖胞苷（150mg/m²，第1 - 4天）。WBRT采用1.8Gy分割剂量。之后计划每4周进行一次鞘内化疗，持续6个月。对两名长期存活者进行了治疗后神经认知评估。
4例接受静脉注射及鞘内注射诱导化疗的患者中有2例疾病进展，立即开始放疗。14例患者中有6例接受了50.4Gy的WBRT，4例患者接受了39.6Gy的WBRT，随后进行10.8Gy的追加照射。5例患者在治疗早期死亡，原因是全身状况恶化或疾病进展。中位生存期为41个月（95%置信区间：6 - 79个月），3年和5年生存率分别为59%和42%。6例患者存活了3年，两名较年轻的患者仍存活（>12年）。他们仅表现出轻微的神经认知功能损害，无临床相关性。
这种基于WBRT联合鞘内注射Ara-C预防脑膜播散及静脉注射Ara-C的方案具有显著的长期生存率且毒性适中。静脉化疗的价值目前正在前瞻性研究中进行探讨。
