a Department of Medical Oncology and Hematology , Princess Margaret Cancer Centre , Toronto, Canada.
b Toronto Radiation Medicine Program, Princess Margaret Cancer Centre , Toronto, Canada.
Leuk Lymphoma. 2019 Feb;60(2):349-357. doi: 10.1080/10428194.2018.1474524. Epub 2018 Jul 3.
The precise role of radiation therapy in primary central nervous system lymphoma (PCNSL) remains controversial. We reviewed the records of all patients treated for PCNSL at our center between 2004 and 2015. A total of 103 patients treated with either chemotherapy alone (n = 30), radiotherapy alone (n = 36), or combined-modality treatment (n = 37) were analyzed. The median progression-free survival (PFS) and overall survival (OS) were 13.9 and 20.9 months, respectively. Of those who received chemotherapy, 52.2% achieved complete response/ unconfirmed complete response (CR/Cru) after induction; a trend for improved PFS was observed for those who received consolidation WBRT (NR vs. 30.1 months, p = .092) but not OS (NR vs. 31.6 months, p = .283). Patients who achieved a partial response with chemotherapy and proceeded with WBRT had a similar long-term survival to those who achieved CR/CRu with chemotherapy without WBRT (PFS 15.2 vs. 30.1 months, p = .888; OS 22.0 vs. 31.6 months, p = .340). Consolidation WBRT improved PFS, but not OS, and this must be balanced against possible risks of neurotoxicity.
放疗在原发性中枢神经系统淋巴瘤（PCNSL）中的确切作用仍存在争议。我们回顾了 2004 年至 2015 年间在我们中心接受 PCNSL 治疗的所有患者的记录。共分析了 103 例单独接受化疗（n=30）、单独放疗（n=36）或联合治疗（n=37）的患者。无进展生存期（PFS）和总生存期（OS）的中位数分别为 13.9 个月和 20.9 个月。接受化疗的患者中，52.2%在诱导后达到完全缓解/不确定完全缓解（CR/Cru）；接受巩固全脑放疗（WBRT）的患者 PFS 有改善趋势（NR 与 30.1 个月，p=0.092），但 OS 无差异（NR 与 31.6 个月，p=0.283）。接受化疗达到部分缓解并接受 WBRT 的患者与未接受 WBRT 而达到 CR/Cru 的患者具有相似的长期生存（PFS 15.2 与 30.1 个月，p=0.888；OS 22.0 与 31.6 个月，p=0.340）。巩固性 WBRT 可改善 PFS，但不能改善 OS，这必须与神经毒性的潜在风险相平衡。
