Hodson D J, Bowles K M, Cooke L J, Kläger S L, Powell G A, Laing R J, Grant J W, Williams M V, Burnet N G, Marcus R E
Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.
Clin Oncol (R Coll Radiol). 2005 May;17(3):185-91. doi: 10.1016/j.clon.2004.10.007.
Current treatment for primary central nervous system lymphoma (PCNSL) involves high-dose methotrexate (HDMTX) with or without radiotherapy. Many published studies describing this approach include a highly selected group of patients. We report a single-centre experience of unselected cases of PCNSL.
We retrospectively reviewed the case notes of 55 consecutive patients diagnosed with biopsy-proven PCNSL between 1995 and 2003 at Addenbrooke's Hospital Cambridge, UK. We describe the treatment and outcome, including survival, treatment-related toxicity and long-term functional disability.
At diagnosis, 45% of patients were considered unfit to receive treatment with HDMTX, owing to poor performance status or comorbidity. These patients had a median survival of 46 days and may not have been included in other published studies. The remaining patients were treated with a chemotherapy regimen, which included HDMTX. Patients who received at least one cycle of a chemotherapy containing HDMTX had a median survival of 31 months. Forty per cent did not complete planned chemotherapy owing to toxicity, disease progression or death. The median survival of patients treated with HDMTX aged 60 years compared with patients aged under 60 years was 26 months vs 41 months (P = 0.07), respectively. Younger patients treated with HDMTX, who achieved complete remission with chemotherapy, had a median survival of 56 months. We identified a high incidence of functional disability among survivors, resulting from a combination of the tumour itself, the neurosurgical procedure required for diagnosis and the late neurotoxicity of combined chemoradiotherapy.
The treatment of PCNSL is associated with significant early and late toxicity. Further attempts to improve treatment should address mechanisms to reduce this toxicity. In particular, the benefit of radiotherapy in patients who achieve complete remission with HDMTX will remain uncertain until it is addressed in a multicentre, randomised trial.
原发性中枢神经系统淋巴瘤（PCNSL）的当前治疗方法包括使用或不使用放射疗法的大剂量甲氨蝶呤（HDMTX）。许多描述这种方法的已发表研究纳入的是经过高度挑选的患者群体。我们报告了一组未经挑选的PCNSL病例的单中心经验。
我们回顾性分析了1995年至2003年期间在英国剑桥阿登布鲁克医院连续诊断为经活检证实的PCNSL的55例患者的病历。我们描述了治疗方法和结果，包括生存率、治疗相关毒性和长期功能残疾情况。
诊断时，45%的患者因身体状况差或合并症而被认为不适合接受HDMTX治疗。这些患者的中位生存期为46天，可能未被纳入其他已发表的研究。其余患者接受了包括HDMTX在内的化疗方案治疗。接受至少一个含HDMTX化疗周期的患者的中位生存期为31个月。40%的患者因毒性、疾病进展或死亡而未完成计划的化疗。60岁及以上接受HDMTX治疗的患者与60岁以下患者的中位生存期分别为26个月和41个月（P = 0.07）。接受HDMTX治疗且化疗后达到完全缓解的年轻患者的中位生存期为56个月。我们发现幸存者中功能残疾的发生率很高，这是由肿瘤本身、诊断所需的神经外科手术以及放化疗联合的晚期神经毒性共同导致的。
PCNSL的治疗伴有显著的早期和晚期毒性。进一步改善治疗的尝试应着眼于降低这种毒性的机制。特别是，对于使用HDMTX达到完全缓解的患者，放疗的益处直到在多中心随机试验中得到验证之前仍不确定。
