Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, 460 W 10th Avenue, Columbus, OH, 43210, USA.
Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA.
J Neurooncol. 2020 Apr;147(2):465-476. doi: 10.1007/s11060-020-03444-5. Epub 2020 Feb 27.
The standard of care for CNS lymphoma typically includes high dose methotrexate followed by whole brain radiation therapy, but there is an increased risk of neurotoxicity with this regimen. In our institution, we offered stereotactic radiosurgery (SRS) for disease refractory to HD-MTX in a subset of patients. A search of the literature on this modality for CNS lymphoma was also conducted.
Medical records of six patients who received partial brain radiation therapy for persistent CNS lymphoma were reviewed. SRS was given via 1-3 fractions to doses of 21 or 24 Gy. PubMed, SCOPUS, and Cochrane Library databases were systematically searched for articles reporting on outcomes for CNS lymphoma treated with SRS.
Six patients (eleven lesions) were treated with SRS for CNS lymphomas. Median follow up was 15.6 months (range 3.3-37.8). Median RT dose per lesion was 21 Gy and median time to progression was 12.7 months. Median overall survival was not reached. Four patients had distant intracranial failure with two developing local recurrence. The search strategy yielded 16 studies of which only one was prospective and included a control group. 183 out of 256 evaluated lesions (69%) responded completely to treatment and 13 of 204 patients (6%) recurred within the treatment area at last follow-up. Overall, the treatment was well tolerated.
SRS may provide favorable local control in patients with refractory CNS lymphomas. A prospective trial is warranted to validate the efficacy of such an approach.
中枢神经系统淋巴瘤的标准治疗方法通常包括大剂量甲氨蝶呤（HD-MTX）后全脑放疗，但该方案有增加神经毒性的风险。在我们医院，对于 HD-MTX 治疗无效的疾病，我们会为一部分患者提供立体定向放射外科手术（SRS）。我们还对该治疗模式治疗中枢神经系统淋巴瘤的文献进行了检索。
对 6 例接受部分脑放疗治疗持续性中枢神经系统淋巴瘤的患者的病历进行了回顾。SRS 采用 1-3 次分割，剂量为 21 或 24Gy。通过 PubMed、SCOPUS 和 Cochrane Library 数据库系统地检索了报告用 SRS 治疗中枢神经系统淋巴瘤的结果的文章。
6 例患者（11 个病灶）接受 SRS 治疗中枢神经系统淋巴瘤。中位随访时间为 15.6 个月（范围 3.3-37.8）。中位每个病灶的放疗剂量为 21Gy，中位进展时间为 12.7 个月。中位总生存期未达到。4 例患者发生远处颅内失败，其中 2 例出现局部复发。检索策略产生了 16 项研究，其中只有 1 项是前瞻性的，且包含对照组。256 个评估病灶中有 183 个（69%）完全缓解，204 例患者中有 13 例（6%）在最后一次随访时在治疗区域复发。总的来说，治疗耐受性良好。
SRS 可能为难治性中枢神经系统淋巴瘤患者提供良好的局部控制。需要进行前瞻性试验来验证这种方法的疗效。
