原发性中枢神经系统淋巴瘤患者局部或全脑放疗后的生存及进展情况比较——德国放射肿瘤学会神经放射肿瘤学工作组（DEGRO AG-NRO）大型多中心分析结果
Comparison of survival and progression after focal- or whole brain radiotherapy in patients with primary CNS lymphoma - Results from a large multicenter analysis of the German Society of Radiation Oncology's Neuro-Radio-Oncology Working Group (DEGRO AG-NRO).
作者信息
Heider Sina, Allwohn Luisa, Rühle Alexander, Ehret Felix, Kaul David, Oertel Michael, Pepper Niklas B, Hoffmann Elgin, Bodensohn Raphael, Ruder Arne, Popp Ilinca, Merten Roland, Eich Hans T, Bernhardt Denise, Schneller Folker, Schorb Elisabeth, Wielenberg Nanna, Combs Stephanie E, Grosu Anca L, Nicolay Nils H, Seidel Clemens
机构信息
Department of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charitéplatz 1, 10117 Berlin, Germany.
出版信息
Radiother Oncol. 2025 Aug;209:110984. doi: 10.1016/j.radonc.2025.110984. Epub 2025 Jun 7.
BACKGROUND AND PURPOSE
Primary central nervous system lymphoma (PCNSL) is a rare but aggressive disease. The application of radiotherapy (RT) as part of treatment usually involved whole-brain radiotherapy (WBRT). Focal radiotherapy (fRT) might be locally active, but comparative outcome data is lacking.
MATERIALS AND METHODS
Data from a multicenter registry of the German Society of Radiation Oncology's Neuro-Radio-Oncology Working Group (DEGRO AG-NRO) was analyzed. Patients treated for PCNSL between 2007 and 2023 who received RT at any stage of their disease were included. Kaplan-Meier and Cox proportional hazards regression analyses were conducted to compare survival between focal (fRT) and whole-brain radiotherapy (WBRT).
RESULTS
Survival data of 151 patients from eight centers were available. The median age at diagnosis was 66.5 years, and the median Eastern Cooperative Oncology Group Performance Status Scale (ECOG PS) was 2. Eighteen percent of patients (n = 27) received primary RT, 33 % (n = 49) consolidation RT, and 49 % (n = 73) RT for recurrent disease. Median overall survival (OS) from diagnosis was 24.1 months (95 % CI: 14.7-33.4), and median survival after RT was 7.2 months (95 % CI: 4.5-10.0). In patients treated with fRT (n = 28) median OS was 67.6 months (95 % CI: 35.7-99.6) compared to 20.1 months after WBRT (n = 123, 95 % CI: 10.5-29.8) (HR = 0.5, p = 0.016). Median survival after RT was also longer with fRT (44.0 months, 95 % CI: 5.9-82.1) than with WBRT (5.8 months, 95 % CI: 3.2-8.4) (HR = 0.5, p = 0.017). In recurrent disease median PFS after use of fRT was 3.8 months, compared to 3.0 months after WBRT (p = 0.164). After fRT, in 16/28 (39 %) patients tumor progression was observed (2/16 in-field, 3/16 out-field, 3/16 mixed, 8/16 unknown). In multivariate Cox-regression analysis, histology other than diffuse large B-cell lymphoma (HR = 0.345, p < 0.01) and fRT (HR = 0.518, p < 0.05) remained independently associated with improved OS.
CONCLUSION
fRT may be a beneficial treatment option for patients with PCNSL and needs to be studied further in prospective clinical trials.
背景与目的
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见但侵袭性强的疾病。放射治疗（RT）作为治疗的一部分通常包括全脑放疗（WBRT）。局部放疗（fRT）可能具有局部活性，但缺乏比较性的疗效数据。
材料与方法
分析了德国放射肿瘤学会神经放射肿瘤学工作组（DEGRO AG-NRO）多中心登记的数据。纳入2007年至2023年间因PCNSL接受过任何阶段放疗的患者。进行了Kaplan-Meier和Cox比例风险回归分析，以比较局部放疗（fRT）和全脑放疗（WBRT）之间的生存率。
结果
来自八个中心的151例患者的生存数据可用。诊断时的中位年龄为66.5岁，东部肿瘤协作组体能状态量表（ECOG PS）的中位值为2。18%的患者（n = 27）接受了初始放疗，33%（n = 49）接受巩固放疗，49%（n = 73）接受复发性疾病放疗。诊断后的中位总生存期（OS）为24.1个月（95%CI：14.7 - 33.4），放疗后的中位生存期为7.2个月（95%CI：4.5 - 10.0）。接受fRT治疗的患者（n = 28）的中位OS为67.6个月（95%CI：35.7 - 99.6），而接受WBRT治疗后的中位OS为20.1个月（n = 123，95%CI：10.5 - 29.8）（HR = 0.5，p = 0.016）。fRT放疗后的中位生存期（44.0个月，95%CI：5.9 - 82.1）也比WBRT（5.8个月，95%CI：3.2 - 8.4）更长（HR = 0.5，p = 0.017）。在复发性疾病中，使用fRT后的中位无进展生存期（PFS）为3.8个月，而WBRT后为3.0个月（p = 0.164）。fRT后，16/28（39%）的患者观察到肿瘤进展（16例中有2例为野内进展，3例为野外进展，3例为混合进展，8例进展部位不明）。在多变量Cox回归分析中，除弥漫性大B细胞淋巴瘤外的组织学类型（HR = 0.345，p < 0.01）和fRT（HR = 0.518，p < 0.05）仍然与OS改善独立相关。
结论
fRT可能是PCNSL患者的一种有益治疗选择，需要在前瞻性临床试验中进一步研究。
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