Non-AIDS primary CNS lymphoma: first example of a durable response in a primary brain tumor using enhanced chemotherapy delivery without cognitive loss and without radiotherapy.
Non-AIDS primary CNS lymphoma: first example of a durable response in a primary brain tumor using enhanced chemotherapy delivery without cognitive loss and without radiotherapy.
复制标题
DOI：
--
复制
发表时间：
1996-05
期刊：
影响因子：
--
通讯作者：
S. A. Dahlborg;W. Henner;Crossen;Tableman Cm;Annie Petrillo;R. Braziel;E. Neuwelt
中科院分区：
文献类型：
--
作者：
S. A. Dahlborg;W. Henner;Crossen;Tableman Cm;Annie Petrillo;R. Braziel;E. Neuwelt
目的在接受基于甲氨蝶呤的化疗并破坏渗透性血脑屏障且有或没有先前颅放射治疗的患者中评估放射学肿瘤反应和生存率。患者和方法 1982 年 1 月至 1992 年 3 月，58 名经组织学证实患有原发性中枢神经系统淋巴瘤（主要是大细胞淋巴瘤或免疫母细胞淋巴瘤）的非 AIDS 患者（38 名男性，20 名女性）在俄勒冈健康科学大学接受治疗。第 1 组患者（n=19）在转诊前接受了颅脑放疗；第 1 组患者（n=19）在转诊前接受了头颅放疗；第 2 组 (n=39) 接受了初始血脑屏障破坏化疗。年龄范围从 5 岁到 71 岁（中位数 57 岁）；纳入时卡诺夫斯基表现状态为 40% 至 100%（中位数为 80），并且所有人都接受了广泛的基线神经心理学评估。结果 两组患者特征无显着差异。在 15 名可评估的 I 组患者中，14 名患者表现出客观缓解，14 名患者中的 7 名 (50%) 实现了完全缓解。在第 2 组中，35 名可评估患者中有 34 名表现出客观缓解，其中 34 名患者中有 29 名出现完全缓解。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，19 名第 2 组患者和 2 名第 1 组患者还活着。 23 名患者完成了广泛的神经心理学随访（距基线长达 7 年），结果表明接受初始化疗和血脑屏障破坏的患者的认知功能得到保留或改善，尤其是 60 岁以上的患者。结论 生存曲线的平台期表明，部分原发性中枢神经系统淋巴瘤患者可以通过化疗和血脑屏障破坏而治愈，而不会出现与颅脑放射相关的神经系统后遗症。
PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.