Dahlborg S A, Henner W D, Crossen J R, Tableman C M, Petrillo A, Braziel R, Neuwelt E A
Oregon Health Sciences University, Department of Neurology, Portland 97201-3098, USA.
Cancer J Sci Am. 1996 May-Jun;2(3):166-74.
Radiographic tumor response and survival were evaluated in patients receiving methotrexate-based chemotherapy with osmotic blood-brain barrier disruption with or without antecedent cranial radiation.
Fifty-eight non-AIDS patients (38 males, 20 females) with histologically confirmed primary central nervous system lymphoma, primarily large cell or immunoblastic, were treated at the Oregon Health Sciences University from January 1982 through March 1992. Group 1 patients (n=19) received cranial radiation prior to referral; Group 2 (n=39) received initial blood-brain barrier disruption chemotherapy. Ages ranged from 5 to 71 years (median, 57); Karnofsky performance status was 40% to 100% on inclusion (median, 80) and all underwent extensive baseline neuropsychological evaluation.
There was no significant difference in patient characteristics between the two groups. In 15 evaluable Group I patients, 14 demonstrated objective response and 7 of 14 (50%) achieved complete response. In Group 2, 34 of 35 evaluable patients demonstrated objective response, including 29 of 34 with complete response. Estimated median survival times for Group 1 and Group 2 patients were 16 and 41 months, respectively. Currently, 19 Group 2 patients and 2 Group 1 patients are alive. Extensive neuropsychological follow-up (up to 7 years from baseline) was completed in 23 patients, which demonstrated preservation or improved cognitive function in those receiving initial chemotherapy and blood-brain barrier disruption, most notably in patients older than 60 years.
A plateau in survival curves suggests that a portion of primary central nervous system lymphoma patients may be cured with chemotherapy and blood-brain barrier disruption without the neurologic sequelae associated with cranial radiation.
评估接受基于甲氨蝶呤的化疗并联合渗透性血脑屏障破坏（伴或不伴先行颅脑放疗）的患者的影像学肿瘤反应和生存率。
1982年1月至1992年3月期间，俄勒冈健康科学大学对58例非艾滋病患者（38例男性，20例女性）进行了治疗，这些患者经组织学确诊为原发性中枢神经系统淋巴瘤，主要为大细胞型或免疫母细胞型。第1组患者（n = 19）在转诊前接受了颅脑放疗；第2组（n = 39）接受了初始血脑屏障破坏化疗。年龄范围为5至71岁（中位数为57岁）；纳入时卡氏功能状态为40%至100%（中位数为80），所有患者均接受了广泛的基线神经心理学评估。
两组患者的特征无显著差异。在15例可评估的第1组患者中，14例显示出客观反应，14例中的7例（50%）达到完全缓解。在第2组中，35例可评估患者中的34例显示出客观反应，包括34例中的29例完全缓解。第1组和第2组患者的估计中位生存时间分别为16个月和41个月。目前，第2组有19例患者和第1组有2例患者存活。23例患者完成了广泛的神经心理学随访（从基线起长达7年），结果显示接受初始化疗和血脑屏障破坏的患者认知功能得以保留或改善，60岁以上患者尤为明显。
生存曲线的平台期表明，一部分原发性中枢神经系统淋巴瘤患者可通过化疗和血脑屏障破坏治愈，而无颅脑放疗相关的神经后遗症。
