Stereotactic radiosurgery in combination with up-front high-dose methotrexate as a first-line treatment for newly diagnosed primary central nervous system lymphoma
Stereotactic radiosurgery in combination with up-front high-dose methotrexate as a first-line treatment for newly diagnosed primary central nervous system lymphoma
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DOI：
10.1007/s11060-015-1786-1
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发表时间：
2015-06-01
影响因子：
3.9
通讯作者：
Saeki, Naokatsu
中科院分区：
文献类型：
--
作者：
Hirono, Seiichiro;Iwadate, Yasuo;Saeki, Naokatsu
大剂量甲氨蝶呤（HD-MTX）治疗原发性中枢神经系统淋巴瘤（PCNSL）后，立体定向放射外科（SRS）代替全脑放疗（WBRT）的疗效尚不清楚。阐明SRS联合预先HD-MTX是否可补充HD-MTX在初始HD-MTX治疗后残留或难治性病变中的作用。作者对HD-MTX一线治疗后接受SRS的新诊断PCNSL患者进行了回顾性分析。分析局部控制（LC）、无进展生存期（PFS）、复发模式、挽救治疗、总生存期（OS）、Karnofsky体力状态（KPS）、日常生活活动能力（ADL）以及放射外科参数。20名患者对51处病变进行了SRS，中位体积为0.45 cm（3）。SRS时的中位年龄为67岁（范围37-82岁）。SRS时的KPS中位数为90。2年时的LC率为86.0%，SRS后的中位PFS为17个月，需要额外的SRS和化疗。中位OS为52个月。未观察到与SRS相关的显著副作用。术后随访13个月，ADL功能保持良好。在SRS时KPS为1/1000日元90的患者表现出更长的ADL保留时间（SRS后32个月）。在没有WBRT的情况下，在前期HD-MTX之后的SRS提供了极好的LC、可接受的OS和较长的ADL保存期。这些益处可能会更受重视，尤其是在KPS良好的患者中，但应在大量患者人群中进行验证。
The efficacy of stereotactic radiosurgery (SRS) instead of whole brain radiotherapy (WBRT) following high-dose methotrexate (HD-MTX) for primary central nervous system lymphoma (PCNSL) is unclear. To clarify whether SRS in combination with up-front HD-MTX supplements the effect of HD-MTX in remaining or refractory lesions after initial HD-MTX treatment. The authors conducted a retrospective review for newly diagnosed PCNSL patients who underwent SRS after HD-MTX as a first-line treatment. The local control (LC), the progression-free survival (PFS), the recurrence patterns, the salvage treatments, the overall survival (OS), the Karnofsky Performance Status (KPS), the activities of daily living (ADL) were analyzed as well as radiosurgical parameters. Twenty patients underwent SRS for 51 lesions with the median volume of 0.45 cm(3). The median age at SRS was 67 (range 37-82). The median KPS at SRS was 90. The LC rate at 2 years was 86.0 %, the median PFS after SRS was 17 months, necessitating additional SRS and chemotherapy. The median OS was 52 months. No significant side effects related to SRS were observed. During follow-up period, the good ADL preservation was achieved for 13 months from SRS. Patients with KPS a parts per thousand yen 90 at SRS demonstrated longer ADL preservation (32 months from SRS). SRS following up-front HD-MTX without WBRT provided excellent LC, acceptable OS and the long ADL preservation period. These benefits may be more emphasized especially in patients with good KPS, but should be validated in a large patient population.