Efficacy Of Temozolomide Combined With Methotrexate In The Treatment Of Recurrent Central Nervous System Lymphoma After Operation

Objective:By comparing temozolomide with high-dose methotrexate and high-dose methotrexate combined with whole-brain radiotherapy,the curative efficacy of temozolomide combined with high-dose methotrexate can be probed.Methods:Retrospective analysis of 32 patients aged 45-66 years and physical status score 60-90 points with recurrent PCNSL from January 2010 to April 2016 in Dalian.These patients had relapsed after surgical resection with first-line chemotherapy.all patients were diagnosed with non-Hodgkin’s diffuse large B-cell lymphoma confirmed by pathological histopathology after recurrence.Among them,16 patients who received temozolomide combined with high-dose methotrexate were treated as the observation group while the remaining 16 patients who received high-dose methotrexate combined with whole brain radiotherapy served as the control group.All patients in the observation group received a combination chemotherapy regimen of temozolomide and high-dose methotrexate.Patients in the control group received high-dose methotrexate combined with whole-brain radiotherapy.Completion of treatment between the two groups of patients,comparing the observation group and the control group before and after treatment in the imaging performance on treatment efficiency(according to the evaluation criteria of solid tumor efficacy RECIST),PCNSL tumor-related laboratory tests(blood LDH,hematuria β2 microglobulin)changes the degree,adverse reaction rate,and survival rate were evaluated.SPSS20.0 computer medical analysis and statistics software was used for statistical analysis of data.P <0.05 was statistically significant.Results:After treatment,the follow-up period was 6-18 months.The imaging group had an effective rate of 43.75% in the control group and 87.5% in the observation group.The observation group had higher efficiency than the control group(X~2=7.944 P<0.05).The treatment group in the observation group was superior to the control group in terms of imaging efficiency.The PCNSL tumor-related laboratory parameters(blood LDH,hematuria β2 microglobulin)were lower in the observation group than in the control group(P<0.05),so the observation group treatment program was superior to the control group in reducing PCNSL tumor-related laboratory indicators.In adverse reactions,there was no significant difference in the incidence of gastrointestinal disorders,dizziness,alopecia,and liver and kidney dysfunction between the observation group and the control group(P>0.05),but the bone marrow suppression in the observation group was lower than that in the control group(P<0.05),so the treatment regimen in the observation group was less than that in the control group in adverse reactions to myelosuppression.The median survival time of the observation group and the control group were(16.2±2.2)and(13.4±0.8),respectively.The median survival time of the observation group was higher than that of the control group,and the difference was statistically significant(X~2=4.16 P=0.041).Therefore,the median survival time of the observation group was better than that of the control group.Conclusions:Temozolomide combined with high-dose methotrexate is more effective than highdose methotrexate combined with whole-brain radiotherapy for the treatment of recurrent central nervous system lymphomaand it is worthy of further study.