Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States; The Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca (USAL), Salamanca, Spain; University California, San Francisco, Department of Neurological Surgery, Skull Base and Cerebrovascular Laboratory, CA, United States.
Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States.
Clin Neurol Neurosurg. 2021 Feb;201:106457. doi: 10.1016/j.clineuro.2020.106457. Epub 2020 Dec 29.
The purpose of this study was to compare the progression of Primary Central Nervous System Lymphoma (PCNSL) in patients treated with methotrexate (MTX) versus those treated with a combination of Stereotactic Radiosurgery (SRS) and MTX. Progression was measured via brain lesion count and tumor volume.
This observational and prospective cohort study evaluated the outcome of SRS treatment of PCNSL in one hundred twenty-eight subjects. We analyzed baseline, prospective, and retrospective data of patients enrolled in the brain tumor registry between June 2010 and August 2017. Seventy-three patients were treated exclusively with MTX while the remaining fifty-five patients received a combination of SRS and MTX. Strict inclusion and exclusion criteria were established.
Mean survival rate for patients receiving combined SRS and MTX treatment was significantly higher (52.6 months) compared to the MTX group (19.8 months); p = 0.0029. At the 36 months follow-up, patients treated with SRS and MTX also had a lower rate of tumor progression (32.7 %) than the MTX group (95.9 %); p = 0.00192. Local tumor control was achieved in all patients treated with SRS. No clinical toxicity was observed in this group.
Clinical results obtained from this observational study highlight the potential effectiveness of SRS in the treatment of PCNSL. Although treatment outcomes have improved in the past years, additional evidence in the clinical design of randomized trials is needed to evaluate the strength of this treatment in specific situations.
本研究旨在比较单纯接受甲氨蝶呤（MTX）治疗与接受立体定向放射外科（SRS）联合 MTX 治疗的原发性中枢神经系统淋巴瘤（PCNSL）患者的疾病进展情况。通过脑部病灶计数和肿瘤体积来衡量进展情况。
本观察性和前瞻性队列研究共评估了 128 例 SRS 治疗 PCNSL 的患者的预后。我们分析了 2010 年 6 月至 2017 年 8 月期间入组脑肿瘤登记处的患者的基线、前瞻性和回顾性数据。73 例患者仅接受 MTX 治疗，其余 55 例患者接受 SRS 联合 MTX 治疗。建立了严格的纳入和排除标准。
联合 SRS 和 MTX 治疗的患者的中位生存率明显较高（52.6 个月），明显优于 MTX 组（19.8 个月）；p = 0.0029。在 36 个月的随访中，接受 SRS 和 MTX 治疗的患者肿瘤进展率也明显较低（32.7%），明显优于 MTX 组（95.9%）；p = 0.00192。所有接受 SRS 治疗的患者均实现了局部肿瘤控制。该组未观察到临床毒性。
本观察性研究的临床结果突出了 SRS 在治疗 PCNSL 方面的潜在有效性。尽管近年来治疗结果有所改善，但需要在临床设计随机试验中提供更多证据来评估这种治疗在特定情况下的效力。
