替莫唑胺为主的化疗联合放疗治疗原发中枢神经系统淋巴瘤的临床观察

王勇; 岳晓; 朱玉方; 陶荣杰; 徐军

doi:10.3969/j.issn.1000-8179.2012.23.015

替莫唑胺为主的化疗联合放疗治疗原发中枢神经系统淋巴瘤的临床观察

doi: 10.3969/j.issn.1000-8179.2012.23.015

王勇^①,
岳晓^②,
朱玉方^②,
陶荣杰^②,
徐军^②, ,

①.
济南大学山东省医学科学院医学与生命科学学院（济南市250022）
②.
山东省肿瘤医院神经外科

详细信息

通讯作者:
徐军 xujunmail@163.com

计量
- 文章访问数: 21
- HTML全文浏览量: 2
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2012-05-03
- 修回日期: 2012-06-26

Clinical Observation of Primary Central Nervous System Lymphoma Patients with Treatment of Temozolomide-based Chemotherapy and Radiation Therapy Treatments

Yong WANG^①,
Xiao YUE^②,
Yufang ZHU^②,
Rongjie TAO^②,
Jun XU^{②
, ,}

①.
Shandong Academy of Medical Sciences, School of Medicine and Life Sciences, University of Ji'nan, Ji'nan 250022, China
②.
Department of Neurosurgery, Shandong Tumor Hospital, Ji'nan 250117, China

More Information

Corresponding author: Jun XU; E-mail: xujunmail@163.com

摘要

摘要: 目的评价以替莫唑胺为主的化疗联合放疗治疗原发中枢神经系统淋巴瘤(PCNSL)的疗效及不良反应。方法对2006年6月至2012年3月山东省肿瘤医院收治的24例PCNSL患者采用全脑放疗同步替莫唑胺化疗之后, 给予替莫唑胺+奈达铂+长春新碱化疗方案行6~8个周期的辅助化疗。观察患者肿瘤缓解状态、总生存期及不良反应。结果 24例均完成治疗。随访3~63个月, 中位生存时间为25个月, 治疗后CR者41.7%(10/24), PR者29.2%(7/24), SD者12.5%(3/24), PD者16.7%(4/24), 客观肿瘤缓解率(ORR)为70.8%。Kaplan-Meier分析显示该治疗方案优于大剂量甲氨蝶呤(HD-MTX)联合放疗治疗PCNSL的效果, 亦优于单药替莫唑胺治疗PCNSL的效果, 且不良反应小。结论替莫唑胺为主的化疗联合放疗治疗PCNSL较安全、效果好。
- 原发性中枢神经系统淋巴瘤 /
- 替莫唑胺 /
- 放射疗法 /
- 药物疗法
Abstract: Objective To evaluate the therapeutic efficacy and toxicity of novel temozolomide-based chemotherapy regimen with radiotherapy for treating primary central nervous system lymphoma (PCNSL). Methods Twenty-four patients were treated by concurrent chemoradiation with temozolomide, after which adjuvant chemotherapy (temozolomide, nedaplatin, and vincristine) was given for 6-8 cycles. Some states were observed, including remission rate, overall survival (OS), and toxicity. Results The 24 patients were followed up for 3 months to 63 months. The median overall survival was 25 months. Ten patients (41.7%) achieved complete response (CR), whereas seven patients (29.2%) achieved partial response (PR). Stable disease was documented in three patients (12.5%), whereas progressive disease occurred in four patients (16.7%). The objective response rate (ORR) was 70.8%. Kaplan-Meier analysis shows that the new treatment is better and results in less adverse reactions than does the combination of high-dose methotrexae (HD-MTX) and radiotherapy, and superior to the single-agent temozolomide treatment of PCNSL. Conclusion The temozolomide-based chemo- therapy regimen with radiotherapy for PCNSL treatment is safe and effective.
- Primary central nervous system lymphoma /
- Temozolomide /
- Radiotherapy /
- Chemotherapy

HTML全文

图 1 本组与国内外同期研究的患者生存曲线比较

Figure 1. Comparison of survival curves in patients of grouping the present study and in studies at home and abroad over the same period

下载: 全尺寸图片幻灯片

表 1 24例PCNSL患者的临床特征

Table 1. The clinical features of 24 patients with PCNSL

参考文献(15)

[1]	Villano JL, Koshy M, Shaikh H, et al. Age, gender, and racial differences in incidence and survival in primary CNS lymphoma[J]. Br J Cancer, 2011, 105(9): 1414-1418. doi: 10.1038/bjc.2011.357
[2]	Ferreri AJ, Marturano E. Primary CNS lymphoma[J]. Best Pract Res Clin Haematol, 2012, 25(1): 119-130. doi: 10.1016/j.beha.2011.12.001
[3]	Gerard LM, Imrie KR, Mangel J, et al. High-dose methotrexate based chemotherapy with deferred radiation for treatment of newly diagnosed primary central nervous system lymphoma. Leuk Lymphoma[J]. Leuk Lymphoma, 2011, 52(10): 1882-1890. doi: 10.3109/10428194.2011.584004
[4]	Küker W, Nägele T, Thiel E, et al. Primary central nervous system lymphomas (PCNSL): MRI response criteria revised[J]. Neurology, 2005, 65(7): 1129-1131. doi: 10.1212/01.wnl.0000178894.51436.54
[5]	郑伟, 聂青, 康静波, 等. 原发中枢神经系统淋巴瘤17例临床分析[J]. 中国肿瘤临床, 2009, 36(10): 554-558. doi: 10.3969/j.issn.1000-8179.2009.10.005
[6]	Makino K, Nakamura H, Hide T, et al. Salvage treatment with temozolomide in refractory or relapsed primary central nervous system lymphoma and assessment of the MGMT status[J]. J Neurooncol, 2012, 106(1): 155-160. doi: 10.1007/s11060-011-0652-z
[7]	DeAngelis LM, Seiferheld W, Schold SC, et al. Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93-10[J]. J Clin Oncol, 2002, 20(24): 4643-4648. doi: 10.1200/JCO.2002.11.013
[8]	Omuro AM, Ben-Porat LS, Panageas KS, et al. Delayed neurotoxicity in primary central nervous system lymphoma[J]. Arch Neurol, 2005, 62(10): 1595-1600.
[9]	Poortmans PM, Nelemans HC, Reiche H, et al. High-dose methotrexate-based chemotherapy central nervous system lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase Ⅱ Trial 20962[J]. J Clin Oncol, 2003, 21(24): 4483-4488. doi: 10.1200/JCO.2003.03.108
[10]	潘浩. 新型烷化剂替莫唑胺的临床应用进展[J]. 中国医院用药评价与分析, 2010, 10(6): 489-490. https://www.cnki.com.cn/Article/CJFDTOTAL-YYPF201006007.htm
[11]	Reni M, Zaja F, Mason W, et al. Temozolomide as salvage treatment in primary brain lymphomas[J]. Br J Cancer, 2007, 96(6): 864-867. doi: 10.1038/sj.bjc.6603660
[12]	Christmann M, Verbeek B, Roos WP, et al. O(6)-Methylguanine-DNA methyltransferase (MGMT) in normal tissues and tumors: Enzyme activity, promoter methylation and immunohistochemistry[J]. Biochim Biophys Acta, 2011, 1816(2): 179-190.
[13]	陈忠平, 杨群英. 神经系统肿瘤化疗手册[M]. 北京: 北京大学医学出版社, 2012: 36-37.
[14]	Ferreri AJ, Licata G, Foppoli M, et al. Clinical relevance of the dose of cytarabine in the upfront treatment of primary CNS lymphomas with methotrexate-cytarabine combination[J]. Oncologist, 2011, 16(3): 336-341. doi: 10.1634/theoncologist.2010-0361
[15]	Fritsch K, Kasenda B, Hader C, et al. Immunochemotherapy with rituximab, methotrexate, procarbazine, and lomustine for primary CNS lymphoma (PCNSL) in the elderly[J]. Ann Oncol, 2011, 22(9): 2080-2085. doi: 10.1093/annonc/mdq712