Department of Neurosurgery, Shandong Cancer Hospital, Jinan 250117, China.
Neurol India. 2013 May-Jun;61(3):260-4. doi: 10.4103/0028-3886.115065.
Primary central nervous system lymphoma (PCNSL) is an aggressive extranodal non-Hodgkin's lymphoma limited to the CNS. Treatment of PCNSL with high-dose methotrexate (HD-MTX)-based chemotherapy and whole-brain radiotherapy (WBRT) is associated with high rates of relapse and severe treatment-related neurotoxicity.
To report our experience of treating newly diagnosed PCNSL with temozolomide, nedaplatin, and vincristine (TNV), as the replacement of HD-MTX, in combination with concurrent chemoradiotherapy.
Newly diagnosed PCNSL patients were given concurrent temozolomide (75 mg/m 2 , orally) daily during WBRT. Then, the TNV regimen was given after four weeks. The TNV regimen consisted of temozolomide (200 mg/m 2 orally: Days 1-5), nedaplatin (80 mg/m 2 intravenous: Day 1), and vincristine (1.4 mg/m 2 intravenous: Day 1). Each cycle was of a duration of four weeks and a maximum of six cycles were applied. The primary end point was response to treatment obtained by magnetic resonance imaging (MRI). Secondary end points were progression-free survival (PFS) and fewer toxic effects.
The study subjects included 14 patients (median age: 53.5, median Karnofsky Performance Scale (KPS): 75). The median number of TNV cycles given was five. RESPONSE TO TREATMENT: Complete response in 12 (85.7%) patients, partial response in 2 (14.3%) patients, and none with progressive disease. The objective response rate was 100%, and median PFS was 21.4 months. Toxicity was relatively mild, which mainly included nausea in six and fatigue in five, grade 3-4 hematotoxicity in one, and abnormal liver functions in five patients. No neurotoxicity has been observed till date.
The efficacy outcomes in this study are comparable to other reported HD-MTX-based regimens plus WBRT, with an added favorable toxicity profile. Prospective, randomized controlled trials are warranted to confirm such results.
原发性中枢神经系统淋巴瘤（PCNSL）是一种局限于中枢神经系统的侵袭性结外非霍奇金淋巴瘤。采用大剂量甲氨蝶呤（HD-MTX）为基础的化疗联合全脑放疗（WBRT）治疗 PCNSL 后，复发率高，且严重的治疗相关神经毒性发生率高。
报告我们采用替莫唑胺、奈达铂和长春新碱（TNV）代替 HD-MTX，并联合同期放化疗治疗初诊 PCNSL 的经验。
在 WBRT 期间，新诊断的 PCNSL 患者每日接受替莫唑胺（75mg/m 2 ，口服）同步治疗。4 周后，给予 TNV 方案。TNV 方案包括替莫唑胺（200mg/m 2 ，口服：第 1-5 天）、奈达铂（80mg/m 2 ，静脉注射：第 1 天）和长春新碱（1.4mg/m 2 ，静脉注射：第 1 天）。每个周期为 4 周，最多应用 6 个周期。主要终点是磁共振成像（MRI）获得的治疗反应。次要终点为无进展生存期（PFS）和毒性反应较少。
研究对象包括 14 例患者（中位年龄：53.5 岁，中位卡氏功能状态评分（KPS）：75）。中位 TNV 周期数为 5 个。治疗反应：12 例（85.7%）患者完全缓解，2 例（14.3%）患者部分缓解，无一例疾病进展。客观缓解率为 100%，中位 PFS 为 21.4 个月。毒性反应相对较轻，主要包括 6 例恶心和 5 例乏力，1 例 3-4 级血液学毒性，5 例肝功能异常。目前尚未观察到神经毒性。
本研究的疗效与其他报道的以 HD-MTX 为基础的方案联合 WBRT 相当，且具有更好的毒性特征。需要前瞻性、随机对照试验来证实这些结果。
