Sierra Del Rio M, Benouaich-Amiel A, Psimaras D, Dehais C, Hoang-Xuan K
Service de neurologie Mazarin, CHU Pitié-Salpêtrière, 47, boulevard de l'hopital, 75651 Paris, France.
Rev Neurol (Paris). 2008 Jun-Jul;164(6-7):569-74. doi: 10.1016/j.neurol.2008.04.001. Epub 2008 May 21.
The incidence of primary CNS lymphoma (PCNSL), which has considerably increased these last years, remains stable in the immunocompetent population, while it is steadily decreasing in the immunosuppressed population. The addition of high dose methotrexate (MTX) based chemotherapy (CT) before whole brain radiotherapy (WBRT) has clearly improved the prognosis of PCNSL with a median survival of three to four years. About 30% of the patients may hope to have a long survival and to be cured. In the elderly (age over 60 years) CT alone (without RT) is recommended as initial treatment. This approach seems useful to avoid RT and to reduce the risk of delayed neurotoxicity due to the combined treatment. In the young population (age less than 60 years), intensive chemotherapy followed by hematopoietic stem cell rescue (ICH) appears as a promising approach in recurrent tumors and potentially as an alternative option to RT as consolidation treatment in newly diagnosed patients. A prospective trial will be activated in France soon randomizing ICH and RT in the initial treatment of PCNSL.
原发性中枢神经系统淋巴瘤（PCNSL）的发病率在过去几年中显著上升，在免疫功能正常人群中保持稳定，而在免疫抑制人群中则持续下降。在全脑放疗（WBRT）前加用基于大剂量甲氨蝶呤（MTX）的化疗（CT）明显改善了PCNSL的预后，中位生存期为三到四年。约30%的患者有望长期存活并治愈。对于老年人（年龄超过60岁），建议单独使用CT（不进行放疗）作为初始治疗。这种方法似乎有助于避免放疗，并降低联合治疗导致迟发性神经毒性的风险。在年轻人群（年龄小于60岁）中，强化化疗后进行造血干细胞救援（ICH）在复发性肿瘤中似乎是一种有前景的方法，并且可能作为新诊断患者巩固治疗中放疗的替代选择。法国很快将启动一项前瞻性试验，对PCNSL初始治疗中的ICH和放疗进行随机分组。
