Baumgartner J E, Rachlin J R, Beckstead J H, Meeker T C, Levy R M, Wara W M, Rosenblum M L
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
J Neurosurg. 1990 Aug;73(2):206-11. doi: 10.3171/jns.1990.73.2.0206.
The incidence of primary central nervous system (CNS) lymphoma has increased rapidly in patients with acquired immunodeficiency syndrome (AIDS) and is predicted to exceed 1800 cases annually by 1991. To characterize the natural history and response to radiation therapy (RT) of these lesions, the authors have reviewed the clinical histories of 55 AIDS patients with biopsy-proven primary CNS lymphomas. The tumors responded both clinically and radiologically to whole-brain RT consisting of 4000 rad in 267-rad fractions over 3 weeks or an equivalent neuroret dose. The mean duration of survival from the appearance of symptoms consistent with the mass lesion was significantly greater in patients who received RT than in those who did not (42 vs. 134 days, p less than 0.5; median 27 vs. 119 days). Autopsy findings showed that patients who did not receive RT died from tumor progression, whereas those who completed RT died of opportunistic infections. Patients with AIDS who are suspected of having primary CNS lymphoma should therefore immediately undergo biopsy and, if the diagnosis is confirmed, whole-brain RT. With early diagnosis and treatment, these tumors respond to, and patients benefit from, RT. Survival of such patients may in future be prolonged by more effective treatments for systemic opportunistic infections.
原发性中枢神经系统（CNS）淋巴瘤在获得性免疫缺陷综合征（AIDS）患者中的发病率迅速上升，预计到1991年每年将超过1800例。为了描述这些病变的自然病史以及对放射治疗（RT）的反应，作者回顾了55例经活检证实为原发性CNS淋巴瘤的AIDS患者的临床病史。这些肿瘤在临床上和放射学上对全脑放疗均有反应，全脑放疗包括在3周内给予4000拉德，每次267拉德，或等效的神经视网膜剂量。从出现与占位性病变一致的症状开始计算，接受放疗的患者的平均生存期明显长于未接受放疗的患者（42天对134天，p小于0.5；中位数27天对119天）。尸检结果显示，未接受放疗的患者死于肿瘤进展，而完成放疗的患者死于机会性感染。因此，怀疑患有原发性CNS淋巴瘤的AIDS患者应立即接受活检，如果诊断得到证实，则应接受全脑放疗。通过早期诊断和治疗，这些肿瘤对放疗有反应，患者也能从放疗中获益。未来，通过更有效的系统性机会性感染治疗方法，此类患者的生存期可能会延长。
