Kwak Yoo-Kang, Choi Byung-Ock, Choi Kyu Hye, Lee Jong Hoon, Sung Soo Yoon, Lee Yun Hee
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Oncotarget. 2017 Nov 10;8(63):106858-106865. doi: 10.18632/oncotarget.22427. eCollection 2017 Dec 5.
The standard treatment for primary central nervous system (CNS) lymphoma is based on chemotherapy. However, there are patients who are not indicated for chemotherapy and when left untreated, the expected functional outcomes for these patients are devastating since the disease causes various neurologic symptoms. Therefore, we assessed the effects of radiotherapy as an alternative therapy in primary CNS lymphoma. Thirty-two patients were diagnosed with primary CNS lymphoma and treated with radiotherapy alone. Patients received whole brain radiotherapy (WBRT) to a median dose of 30 Gy (range, 14.4-50 Gy) and the median total radiotherapy dose was 50 Gy (range, 30-54 Gy). The status on neurologic symptoms before and after radiotherapy was inquired during the regular follow-ups. The progression-free survival (PFS) and overall survival (OS) rates for the enrolled patients were calculated. The median follow-up time was 21 months. All but one of the patients presented with neurologic symptoms. The most common symptoms were hemiparesis and headache. After radiotherapy, these symptoms were relieved in 27 patients (84.4%). The median PFS and OS rates were 15.8 and 16.3 months, respectively. Twenty patients (62.5%) experienced recurrent disease at follow up and among them, fifteen patients (46.9%) had intracranial recurrence. The median intracranial PFS was 19.3 months. Untreated primary CNS lymphoma causes neurologic deficits and the survival after only supportive care is poor. Therefore, when chemotherapy is unfeasible, an alternative treatment should be applied and radiotherapy can be a practical option.
原发性中枢神经系统（CNS）淋巴瘤的标准治疗方法是化疗。然而，有些患者不适合化疗，如果不进行治疗，这些患者的预期功能结局将是毁灭性的，因为该疾病会引发各种神经症状。因此，我们评估了放射治疗作为原发性CNS淋巴瘤替代疗法的效果。32例患者被诊断为原发性CNS淋巴瘤并仅接受了放射治疗。患者接受全脑放射治疗（WBRT），中位剂量为30 Gy（范围为14.4 - 50 Gy），中位总放射剂量为50 Gy（范围为30 - 54 Gy）。在定期随访期间询问放疗前后的神经症状状态。计算入组患者的无进展生存期（PFS）和总生存期（OS）率。中位随访时间为21个月。除1例患者外，所有患者均出现神经症状。最常见的症状是偏瘫和头痛。放疗后，27例患者（84.4%）的这些症状得到缓解。中位PFS和OS率分别为15.8个月和16.3个月。20例患者（62.5%）在随访时出现疾病复发，其中15例患者（46.9%）发生颅内复发。中位颅内PFS为19.3个月。未经治疗的原发性CNS淋巴瘤会导致神经功能缺损，仅接受支持治疗后的生存率很低。因此，当化疗不可行时，应采用替代治疗方法，放射治疗可能是一种可行的选择。
