Kenai Hiroyuki, Yamashita Masanori, Nakamura Takaharu, Asano Tomoshige, Momii Yasutomo, Nagatomi Hirofumi
Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan.
J Neurosurg. 2006 Dec;105 Suppl:133-8. doi: 10.3171/sup.2006.105.7.133.
Although there is no established treatment for primary central nervous system lymphoma (PCNSL), therapeutic protocols involving high-dose methotrexate therapy followed, in some cases, by whole-brain radiotherapy (WBRT) have generally been adopted, and they have yielded relatively favorable results. Gamma Knife surgery (GKS) is a stopgap measure to treat patients with PCNSL. The authors summarize the results of their cases and evaluate the efficacy and usefulness of GKS.
Between June 1999, and June 2005, 22 patients suffering from PCNSL were treated with GKS at the authors' institution and were followed up for more than 6 months. Some combination of chemotherapy and/or WBRT and/or microsurgery had been performed in 18 of the 22 patients before GKS. The remaining four patients had not undergone any previous treatment. In these patients, the mean tumor volume was 4.14 cm3, and the tumors were treated with a mean margin dose of 16.5 Gy to the 52.8% isodose line. Magnetic resonance imaging demonstrated the disappearance of the GKS-treated lesions; however, new lesions were observed in other regions of the brain in 10 patients and repeated GKS was performed in some cases. No local recurrences were observed an average of 19.4 months after GKS, and good level of quality of life (QOL) was maintained during this period.
Gamma Knife surgery should be performed only for local tumor control as a stopgap measure in the treatment of PCNSL. It is noninvasive and safe, and its effects occur rapidly. Its use improves prognosis and enhances the patient's quality of life. Gamma Knife surgery should be considered one of the treatment strategies for patients with PCNSLs.
尽管原发性中枢神经系统淋巴瘤（PCNSL）尚无既定的治疗方法，但通常采用大剂量甲氨蝶呤治疗方案，某些情况下随后进行全脑放疗（WBRT），且已取得相对良好的效果。伽玛刀手术（GKS）是治疗PCNSL患者的一种权宜措施。作者总结了其病例结果并评估了GKS的疗效和实用性。
1999年6月至2005年6月期间，22例PCNSL患者在作者所在机构接受了GKS治疗，并进行了超过6个月的随访。22例患者中有18例在GKS治疗前接受了化疗和/或WBRT和/或显微手术的某种联合治疗。其余4例患者此前未接受过任何治疗。这些患者的平均肿瘤体积为4.14 cm³，肿瘤接受了平均边缘剂量为16.5 Gy至52.8%等剂量线的治疗。磁共振成像显示GKS治疗的病灶消失；然而，10例患者在脑的其他区域观察到新病灶，部分病例进行了重复GKS治疗。GKS治疗后平均19.4个月未观察到局部复发，在此期间维持了良好的生活质量（QOL）水平。
伽玛刀手术仅应作为PCNSL治疗中的一种权宜措施用于局部肿瘤控制。它无创且安全，效果迅速出现。其应用改善了预后并提高了患者的生活质量。伽玛刀手术应被视为PCNSL患者的治疗策略之一。
