The Treatment And Prognostic Factors Of Primary Central Nervous System Lymphoma

Background and Objectives:Primary central nervous system lymphoma (PCNSL) is an uncommon form of non-Hodgkin's lymphoma(NHL) that has been increasing in incidence over the past three decades.PCNSL accountes for only 1%of lymphoma in all parts of our body,and accountes for only 0.3%～1.5%of all brain tumors.The long-term curative effect for most of patients is still poor because of the complexed clinical manifestation in the disease,and the difficulties in diagnosis and treatment.The patient's condition and survival time have been improved due to improvement of the therapy and the use of new therapy methods.There are many ways for the treatment of PCNSL,such as hormone therapy,surgery therapy,radiotherapy,chemotherapy,combined therapy and new methold,according to the symptom and condition of the patients.But there are fit and unfit for every kind of therapies in clinical treatment.One received,unified therapeutic regimen should be determined.The choice of treatment remains controversial.Analysis of the prognosis is important to judgement of patient's prognosis,choice of therapy method,plan for the treatment,distribution of the medical treatment resources reasonably.Approach of prognosis judgement remains to be analyzed.This study is to investigate the short-term and long-term survival of 56 cases patients with PCNSL in our hospital, and to evaluate the prognostic factor systematically,so as to make some help to clinical treatment. Materials and methods:56 cases patients with PCNSL between January 1997 and March 2009 are analyzed.All patients are diagnosed by pathology biopsy after surgery or stereotactic biopsy.There are 41 cases of B-cell lymphoma,and 15 cases ofT-cell lymphoma.38 cases have single-focus,18 cases have multi-focus.Tumors in 16 cases were completely resected.Tumors in 31 cases were partially resected,9 cases were received stereotactic biopsy.17 cases only received radiotherapy after surgery.8 cases only received chemotherapy after surgery.31 cases received combined thearpy with radiotherapy and chemotherapy,in which 18 cases received chemotherapy after radiotherapy,10 cases received radiotherapy after chemotherapy, 3 cases received radiotherapy and chemotherapy synchronously.Whole brain was radiated by 30～40Gy mainly in the radiotherapy,10～20Gy was delivered to GTV in some patients.Chemotherapy with CHOP schedule was used in 22 cases patients. 14 cases received high dose of MTX or combination of high dose of arabinosylcytosin(2—3g/m~2).7 cases received chemotherapy with HD-MTX mainly combined with whole brain radiotherapy.4 cases were performed(MTX 15mg, arabinosylcytosin 50mg,dexamethasone 5mg) by intrathecal injection when chemotherapy.Results:The medium follow-up time was 46.4 months(range,1.0～93.8 months). Of all the patients,CR was 21 cases(37.5%),PR was 14 cases(25.0%),NC was 10 cases(17.9%),PD was 11 cases(19.6%),respectively,and local control rate was 80.4%.LCR of group beyond 60 years old(53.3%)was lower than that of bellow 60 years old(90.2%),P＜0.05;LCR of multi-focus group(61.1%)was lower than that of single-focus group(89.5%),P＜0.05.LCR of group received combined therapy with radiotherapy and chemotherapy(93.5%)was higher than that of group without received combined therapy with radiotherapy and chemotherapy(64.0%),P＜0.05. The medium survival time(MST) was 22.6 months,and the 1-,2-,3-,4-,5-year OS rates was 66.1%,42.8%,34.0%,23.2%,respectively for all patients.5-year OS rate of the group beyond 60 years old was(0.0%)lower than that of bellow 60 years old(31.7%),P＜0.05;5-year OS rate of B-cell lymphoma group(0.0%)was lower than that ofT-cell lymphoma group(34.2%),P＜0.05;5-year OS rate of multi-focus group(0.0%)was lower than that of single-focus group(34.2%),P＜0.05.5-year OS rate of group received(HD-MTX+WBRT)(71.4%) was higher than that of group without received(HD-MTX+WBRT)(16.3%),P＜0.05.The MST of patients without receiving radiotherapy or chemotherapy was only 2 months.The MST of patients with radiotherapy alone after surgery,chemotherapy alone after surgery,combined therapy with radiotherapy and chemotherapy was 20.5,25.3,26.4 months respectively.The MST of patients receiving chemotherapy with HD-MTX and(HD-MTX+WBRT) was 32.5 months and 36.4 months respectively. We didn't think that the sequence of radiotherapy and chemotherapy would affect on the MST of patients.The MST of patients with radiotherapy after chemotherapy was 27.3 months,the MST of patients with chemotherapy after radiotherapy was 25.9months,there were not significant difference(P＞0.05).Conclusions:1.PCNSL is sensitive to radiotherapy and chemotherapy,but it is easy to recur and gives a poor prognosis to the patients.2.The curative effect of combined therapy with radiotherapy and chemotherapy is better than that of radiotherapy alone or chemotherapy alone.3.Chemotherapy with high dose of MTX is effective to the treatment of PCNSL.Chemotherapy with high dose of MTX combined with whole brain radiotherapy is the best choice for the treatment of PCNSL recently.4.The prognostic factors for PCNSL are age,pathologic category,single-focus or multi-focus and chemotherapy HD-MTX plus WBRT therapy or not.