Chemotherapy without radiation therapy as initial treatment for primary CNS lymphoma in older patients
Chemotherapy without radiation therapy as initial treatment for primary CNS lymphoma in older patients
复制标题
化疗联合放疗作为老年患者原发性中枢神经系统淋巴瘤的初始治疗
作者：
R. Freilich;J. Delattre;A. Monjour;L. Deangelis
原发性中枢神经系统淋巴瘤 (PCNSL) 的化疗加放疗 (RT) 与单独放疗相比可显着提高患者生存率，但放疗会产生晚期神经系统后遗症，尤其是老年人。我们治疗了 13 名年龄超过 50 岁（平均年龄 74 岁）的患者，仅用化疗作为 PCNSL 的初始治疗。所有患者均接受甲氨蝶呤 (MTX) 和丙卡巴肼治疗；此外，五名患者接受了塞替派、四名长春新碱、四名长春新碱和阿糖胞苷治疗。 10 例获得完全缓解 (CR)，2 例获得部分缓解 (PR)，1 例通过治疗取得进展。两名眼部淋巴瘤患者对 MTX、丙卡巴肼和长春新碱有反应。达到 CR 或 PR 后复发的 6 名患者中有 4 名接受了额外的化疗或 RT 治疗，其中 3 名达到 CR，1 名达到 PR。 5 名患者在 7.5 至 30 个月时仍处于 CR，1 名患者在 35 个月时仍存活，但疾病进展，6 名患者在 5 至 30.5 个月时死于 PCNSL，1 名患者在诊断后 2 个月因硫过敏而死于 CR。接受治疗的 13 名患者中有 11 名的卡诺夫斯基体能状态有所改善。九名患者在诊断时存在认知缺陷，其中八名在化疗后得到改善。只有一名患者因进展性肿瘤和可能的 MTX 白质脑病而出现新的认知缺陷。单独化疗治疗 PCNSL 对老年人有效，并且消除了放疗相关神经毒性的风险。放疗可以挽救化疗后复发的患者。神经病学 1996；46：435-439
Chemotherapy plus radiation therapy (RT) for primary CNS lymphoma (PCNSL) has significantly improved patient survival over RT alone, but there are late neurologic sequelae of RT, particularly in the elderly.We treated 13 patients over age 50 years (mean age 74 years) with chemotherapy alone as initial treatment for PCNSL. All received methotrexate (MTX) and procarbazine; in addition, five received thiotepa, four vincristine, and four vincristine and cytarabine. Ten achieved a complete response (CR), 2 a partial response (PR), and 1 progressed through treatment. Two patients with ocular lymphoma responded to MTX, procarbazine, and vincristine. Four of six patients who relapsed after achieving a CR or PR were treated with additional chemotherapy or RT, three achieved a CR and one a PR. Five patients remain in CR at 7.5 to 30 months, one is alive at 35 months but with progressive disease, six died of PCNSL at 5 to 30.5 months, and one died in CR of sulfur allergy 2 months after diagnosis. The Karnofsky Performance Status improved in 11 of 13 patients with treatment. Cognitive deficits were present in nine patients at diagnosis and improved in eight of these nine after chemotherapy. Only one patient developed new cognitive deficits, due to progressive tumor and possibly MTX leukoencephalopathy. Chemotherapy alone for PCNSL is effective in the elderly and eliminates the risk of RT-related neurotoxicity. RT can salvage those who relapse after chemotherapy. NEUROLOGY 1996;46: 435-439
DOI：
10.1016/0360-3016(92)90538-s
发表时间：
1992-01-01
影响因子：
7
作者：
NELSON, DF;MARTZ, KL;MURRAY, KJ
通讯作者：
MURRAY, KJ