Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2018 Apr 1;100(5):1146-1154. doi: 10.1016/j.ijrobp.2018.01.003. Epub 2018 Jan 6.
We assessed the efficacy of radiation therapy (RT) in the management of secondary central nervous system (CNS) lymphoma.
The cohort comprised 44 patients with systemic diffuse large B-cell lymphoma (DLBCL) secondarily involving the brain and/or leptomeninges at initial diagnosis or relapse that was treated with RT.
Of these patients, 29 (66%) were in systemic remission when CNS disease was diagnosed. The overall response rate to RT by magnetic resonance imaging was 88% (42% complete, 46% partial). The median overall survival (OS) after RT initiation was 7 months (95% confidence interval 4-10 months). The OS curve plateaued at 31% from 2 to 8 years. OS was superior in patients who achieved a complete or partial response to RT, underwent stem cell transplantation after RT, and had brain parenchymal (vs leptomeningeal) disease. Eight cases of CNS disease progression occurred after RT: 1 involved the brain parenchyma, and 7 involved the spine and/or cerebrospinal fluid and/or meninges.
We conclude that RT is associated with high response rates and may contribute to long-term OS. In addition, RT may provide CNS disease control that facilitates successful salvage with stem cell transplantation in patients with chemotherapy-refractory disease.
我们评估了放疗（RT）在治疗继发性中枢神经系统（CNS）淋巴瘤中的疗效。
该队列包括 44 例初诊或复发时系统性弥漫性大 B 细胞淋巴瘤（DLBCL）合并脑和/或软脑膜受累的患者，这些患者接受了 RT 治疗。
这些患者中，29 例（66%）在 CNS 疾病诊断时处于全身缓解期。磁共振成像（MRI）评估的 RT 总体缓解率为 88%（完全缓解 42%，部分缓解 46%）。RT 开始后中位总生存期（OS）为 7 个月（95%置信区间 4-10 个月）。2-8 年 OS 曲线在 31%处趋于平稳。对 RT 有完全或部分缓解、RT 后行干细胞移植、脑实质（而非软脑膜）受累的患者，OS 更好。8 例 CNS 疾病在 RT 后进展：1 例累及脑实质，7 例累及脊柱和/或脑脊液和/或脑膜。
我们得出结论，RT 与高缓解率相关，并可能有助于长期 OS。此外，RT 可能有助于控制 CNS 疾病，从而为化疗耐药患者的干细胞移植提供挽救治疗机会。
