Juravinski Cancer Centre, Hamilton, ON L8V 5C2, Canada.
Curr Oncol. 2023 Sep 20;30(9):8602-8611. doi: 10.3390/curroncol30090624.
Primary central nervous system lymphoma (PCNSL) is primarily treated with combination chemotherapy, while whole-brain radiotherapy (WBRT) can be used as consolidative treatment or as a salvage option for central nervous system (CNS) relapse. We investigated whether fractionated stereotactic radiosurgery (fSRS) could replace WBRT in cases where patients had poor performance status or minimal disease at the time of consolidation, to spare patients the adverse effects of WBRT. We retrospectively identified 10 patients who completed 14 courses of fSRS for PCNSL or for CNS relapse of systemic lymphoma. Of 14 fSRS treatments, there were 10 distant brain recurrences among 6 patients, occurring on average 13.6 months after fSRS. A total of 4 of the 10 recurrences were treated with further fSRS, and 4 were treated with WBRT. There was one late in-field recurrence after both fSRS and WBRT, which occurred 27 months after fSRS. The median survival after fSRS was 36 months, and side effects after fSRS were minimal. This case series represents a potential treatment option for patients with CNS lymphoma, for whom WBRT is indicated but where the toxic effects of this treatment would be prohibitive.
原发性中枢神经系统淋巴瘤(PCNSL)主要采用联合化疗治疗,而全脑放疗(WBRT)可作为巩固治疗或中枢神经系统(CNS)复发的挽救治疗方法。我们研究了在巩固治疗时患者表现状态差或疾病程度轻微的情况下,是否可以采用分次立体定向放射外科手术(fSRS)替代 WBRT,使患者免受 WBRT 的不良反应。我们回顾性地确定了 10 名完成了 14 个疗程的 fSRS 治疗 PCNSL 或全身淋巴瘤 CNS 复发的患者。在 14 次 fSRS 治疗中,有 6 名患者的 10 个远处脑复发,平均在 fSRS 后 13.6 个月发生。在 10 次复发中有 4 次采用了进一步的 fSRS 治疗,4 次采用了 WBRT。在 fSRS 和 WBRT 后均有 1 例迟发野内复发,发生在 fSRS 后 27 个月。fSRS 后的中位生存期为 36 个月,fSRS 后的副作用极小。该病例系列为 CNS 淋巴瘤患者提供了一种潜在的治疗选择,这些患者需要接受 WBRT,但 WBRT 的毒性作用可能是不可接受的。