Stereotactic Radiosurgery for Primary Central Nervous System Lymphoma.
Stereotactic Radiosurgery for Primary Central Nervous System Lymphoma.
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DOI：
10.7759/cureus.34817
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发表时间：
2023-02
期刊：
影响因子：
--
通讯作者：
Sneed PK
中科院分区：
文献类型：
--
作者：
Wu SY;Braunstein SE;Rubenstein JL;Sneed PK
原发性中枢神经系统淋巴瘤（PCNSL）是罕见的，其治疗主要包括高剂量甲氨蝶呤化疗，放射治疗通常用于持续或进展性疾病。在这项研究中，我们报告了立体定向放射手术（SRS）在PCNSL患者中可能延迟全脑放疗（WBRT）或作为WBRT后的救助的结果。方法：我们对1992年9月至2019年7月期间接受单次或分次SRS治疗32个病灶的20例PCNSL患者进行了单机构回顾性研究。结果SRS的中位年龄为67岁（四分位间距(IQR) = 56 ~ 74岁）。SRS时Karnofsky Performance Status （KPS）中位数为80 （IQR = 50-80）。总共有18例（90%）患者在SRS之前接受了基于甲氨蝶呤的化疗，中位数为8个周期（IQR = 5-10）。共有10例患者在化疗和/或WBRT后复发性疾病接受SRS， 9例患者在单独化疗后持续性疾病接受SRS， 1例患者接受前期SRS。总体而言，5例患者在WBRT后接受了SRS。每组（IQR = 1-5组）中位SRS剂量为16 Gy （IQR = 14-22.5 Gy）。8例患者（40%）在SRS后联合泊马度胺或来那度胺治疗。局部控制率为100%（32/32个病灶，中位随访15个月）。总的来说，16例随访患者中有13例（81%）出现远端脑复发。SRS术后到远处衰竭的中位时间为10个月（IQR = 1-16个月）。3例患者接受补救性SRS， 3例患者接受补救性WBRT。诊断后的中位总生存期为39个月（95%可信区间= 24-54个月）。SRS时KPS与进展时间显著相关（p = 0.002）。SRS后使用来那度胺或泊马度胺与SRS后总生存率的提高相关（3个月vs 14个月，p = 0.035）。初始甲氨蝶呤化疗后合并依托泊苷和阿糖胞苷也与SRS后生存率的提高相关（8个月对47个月，p = 0.028）。结论SRS对PCNSL患者有较好的局部肿瘤控制作用；然而，大多数患者会经历远期进展。SRS可能在WBRT后复发患者的救助设置中发挥作用，或允许在选定的患者中推迟WBRT，尽管在该队列中，全身治疗似乎对结果有很大影响。
Background Primary central nervous system lymphoma (PCNSL) is rare, with a treatment backbone that typically includes high-dose methotrexate-based chemotherapy, with radiation often reserved for persistent or progressive disease. In this study, we report the outcomes of stereotactic radiosurgery (SRS) in patients with PCNSL to potentially defer whole brain radiotherapy (WBRT) or as salvage after WBRT. Methodology We performed a single-institution, retrospective review of 20 patients with PCNSL who received single-fraction or fractionated SRS to 32 lesions between September 1992 and July 2019. Results The median age at SRS was 67 years (interquartile range (IQR) = 56-74 years). The median Karnofsky Performance Status (KPS) at SRS was 80 (IQR = 50-80). In total, 18 (90%) patients received methotrexate-based chemotherapy prior to SRS, with a median of eight cycles (IQR = 5-10). A total of 10 patients received SRS for recurrent disease after chemotherapy and/or WBRT, nine patients received SRS for the persistent disease after chemotherapy alone, and one patient received up-front SRS. Overall, five patients received SRS following WBRT. The median SRS dose was 16 Gy (IQR = 14-22.5 Gy) in one fraction (IQR = 1-5 fractions). Eight patients (40%) were treated with consolidative pomalidomide or lenalidomide following SRS. The local control rate was 100% (32/32 lesions at a median follow-up of 15 months). In total, 13 of 16 (81%) patients with available follow-up experienced distant brain recurrence. The median time to distant failure following SRS was 10 months (IQR = 1-16 months). Three patients received salvage SRS, and three patients received salvage WBRT. The median overall survival from diagnosis was 39 months (95% confidence interval = 24-54 months). KPS at the time of SRS was significantly correlated with time to progression (p = 0.002). The use of lenalidomide or pomalidomide after SRS was associated with improved overall survival after SRS (three vs. 14 months, p = 0.035). Consolidative etoposide and cytarabine after initial methotrexate-based chemotherapy was also associated with improved survival following SRS (eight vs. 47 months, p = 0.028). Conclusions SRS offers effective local tumor control for patients with PCNSL; however, the majority of patients experience distant progression. SRS may have a role in the salvage setting for patients with recurrence after WBRT, or allow deferral of WBRT in select patients, although systemic therapy appears to strongly influence outcomes in this cohort.
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影响因子：
9.9
作者：
Enting, RH;Demopoulos, A;Abrey, LE
通讯作者：
Abrey, LE
影响因子：
3.9
作者：
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影响因子：
45.3
作者：
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影响因子：
15.9
作者：
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通讯作者：
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影响因子：
45.3
作者：
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通讯作者：
Mehta, Minesh P.