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目的 分析脑原发淋巴瘤的临床特点、治疗和预后情况 ,结合文献复习探讨疗效的改进。方法 1990年 4月至 2 0 0 0年 8月收治 19例患者 ,中位年龄 5 1岁 ,均无免疫抑制的证据。初发病灶单发者 11例 ,多发者 8例。 6 8.4 %的病变为B细胞来源 ,中高度恶性多见。 17例手术后放射治疗 ,其中 10例还接受化疗 ;2例未手术直接放射治疗 ,其中 1例还接受化疗。结果 近期疗效良好 ,全组生存时间 9～ 6 5个月 (中位 2 0个月 ) ,1、3、5年生存率分别为 79.0 %、30 .4 %和 8.1%。单因素分析显示患者年龄对生存率有显著影响 ,病灶个数、放射治疗剂量、加用化疗对生存均无显著影响。 4例疗后有无复发不详 ,13例患者疗后出现病变复发 ,复发灶均位于中枢神经系统内 ,其中 7例初发病灶未控或复发 ,6例诊为癌性室管膜炎。神经毒性为主要的治疗并发症。结论 脑原发淋巴瘤发病率近年明显上升 ,疗效不理想 ,6 0岁以上的患者预后不良。增加放射治疗剂量并不能改善肿瘤控制 ,综合治疗的进展有望改进疗效。
Objective To analyze the clinical characteristics, treatment and prognosis of primary brain lymphoma, and to review the literature to improve the curative effect. Methods From April 1990 to August 2000, 19 patients were treated, with a median age of 51 years. There was no evidence of immunosuppression. Initial lesions were single in 11 cases, multiple in 8 cases. 6 8.4% of the lesions were B cell sources, most of which were highly malignant. Seventeen patients underwent postoperative radiotherapy, of whom ten received chemotherapy, two received direct radiotherapy without surgery, and one received chemotherapy. The results of the recent good effect, the whole group of survival time 9 ~ 65 months (median 20 months), 1, 3, 5-year survival rates were 79.0%, 30.4% and 8.1%. Univariate analysis showed that the patient’s age had a significant effect on the survival rate. The number of lesions, the dose of radiotherapy and the addition of chemotherapy had no significant effect on the survival. No recurrence was found in 4 patients after treatment. Thirteen patients relapsed after the treatment. All the recurrences were located in the central nervous system. Among them, 7 patients had primary tumor uncontrolled or recurred, and 6 patients were diagnosed as cancerous ependymalitis. Neurotoxicity is the main therapeutic complication. Conclusions The incidence of primary brain lymphoma is obviously increased in recent years. The curative effect is not satisfactory. Patients over 60 years of age have a poor prognosis. Increasing the dose of radiation does not improve tumor control, and advances in combination therapy are expected to improve outcomes.