【摘要】 目的 研究原发性中枢神经系统淋巴瘤(PCNSL)手术后外照射结合化疗颅内病灶控制效果和毒副反应。方法 回顾分析PCNSL 12例，经手术后病理证实，病理类型以弥漫性大细胞淋巴瘤为主。病灶呈多灶性6例，单灶性6例。男女之比为1：1。中位年龄54岁。外照射采用8MeV-X，全脑DT 30～40Gy，然后局部追加DT 14～20Gy，中位剂量54Gy。化疗9例采用VM-26+Me-CCNU,6周1个疗程，共6个疗程。应用CTX+EADM+VCR+Pred 3例，4周1个疗程，1例用2个疗程，2例用4个疗程。结果 PCNSL经术后放化疗，中位生存期为30个月。1、2、5年生存率分别为83.3%、58.3%、25.0%，其中年龄<60岁者明显优于≥60岁者(P＝0.0419)。单病灶患者明显优于多病灶患者(P=0.0415)。延迟性神经毒性反应，年龄>60岁中占50%(3/6)，年龄<60岁中无明显反应，3～4度造血功能障碍。其中白细胞下降8例，占66.6%，血小板下降5例，占41.6%。结论 PCNSL较一般的NHL具有独特的预后因素。术后放疗在综合治疗中极为重要。近期疗效较明显，常规化疗的作用并不理想，可能与血脑屏障有关，将进一步探索。

    【关键词】 中枢神经系统淋巴瘤；放射治疗；化学疗法；预后

    Postoperative primary central nervous lymphoma: treatment with combined chemotherapy and radiotherapy

    JIN Guo-wen, XIANG Yi-hui, WANG Min-hua,et al.

    Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200052, China

    【Abstract】 Objective To study the local control effects and toxicity of radiotherapy (RT) added to chemotherapy for postoperative primary central nervous lymphoma (PCNSL).Methods Twelve patients with PCNSL were analyzed retrospectively. All were confirmed by histology. The most frequent histological type was diffused large cell lymphoma. Six patients had single-locus lesion and 6 multi-locus lesions. There were 6 males and 6 females, with a median age of 54 years. Total brain irradiation of 30～40Gy was administered with 8MV-X ray and then, a local boost of 14～20Gy was supplemented, with a median does of 54Gy. Chemotherapy was concomitantly given Vm-26+Me-CCNU after 6 weeks over 6 cycles in 9 patients. 3 patents received chemotherapy with CTX+EADM+VCR+Pred regimen after 4 weeks over 2～4 cycles.Results All the patients received radiotherapy combined with chemotherapy, the median survival was 30 months. The 1-,2-and 5-years survival rates were 83.3%,58.3%,25.0%. The rates of PCNSL in the patients who were younger than 60 years were better than that in the patients ≥60 years (P=0.0419). Delayed nervous system toxicity occurred in 50 percent of patients older than 60 years. The bone marrow toxicity included leucopenia and thrombocytopenia.Conclusion PCNSL has a special prognostic factor. Radiotherapy after surgery plays a very important role in comprehensive treatment. The immediate treatment response is significant, but the role of regular chemotherapy is disappointing, which may be related with the blood brain barrier. It needs to be further explored. ......