Clinical Analysis On Diagnosis And Treatment In25Patients With Primary Central Nervous System Lymphoma

Primary central nervous system lymphoma (PCNSL) is a relatively raremalignant tumor in central nervous system, the current clinical diagnosis isdifficult, the therapeutic effect is not satisfactory. The further study of theclinical characteristics, the main diagnosis and effective treatment method forPCNSL, has the important clinical value.Objective:The clinical characteristics and treatment of25patients with PCNSLwere analyzed, the aim was to enhance understanding of diagnosis andtreatment for PCNSL, further improve the present status diagnosis andtreatment.Methods：This study collected the data of25patients with PCNSL who wereadmitted in the Nerve Tumor Surgery, First Hospital of Jilin University duringthe period of between September2009and September2011, andretrospectively analyzed these patient’s age, sex, time of onset, imaging,operation, pathological, chemotherapy and radiation data, and conditions ofprognosis.Results:This group of25patients had no organ transplantation history,malignant tumor and autoimmune disease history, HIV antibodies werenegative. Of these，the17patients were male,8patients were female, male:female=2.1:1. Age of onset was12-73(mean52.4) years, the age of18 patients (72%) was older than50years old, the age of2patients was youngerthan18years old, both accounted for80.0%of the total cases; The course ofdisease was from6days to10months, mean course was3months. Accordingto the clinical manifestation and imaging data, the clinical diagnosis of PCNSLwas determined. All patients were performed surgical removal of the tumors(the complete resection for17patients, the partial resection for8patients).Using the histopathological examination,21patients had a diagnosis of diffuselarge B cell lymphoma (84%),3patients had small B cell lymphoma (12%)，1patient had T cell lymphoma (4%). Five patients (20.0%) received whole brainradiotherapy after operation, their survival times were13-32months, mediansurvival times were22months. Five patients (20.0%) received high dosemethotrexate after surgery, their survival times were17-40months, mediansurvival times were25months. Seven patients (28.0%) combined high dosemethotrexate with whole brain radiotherapy, their survival times were21-48months, median survival times were30months. Because of economic reasons,etc,8patients (32.0%) abandoned chemotherapy and radiotherapy after surgery,their survival times were shortest,3~7months, median survival times were4.5months only.Conclusions：1．The ratio of male and female was2.1:1in this group of25patientswith PCNSL, the mean onset age was52.4years, the age of18patients (72%)was older than50years old, The course of disease was from6days to10months.2．Nuclear magnetic resonance-enhancement scanning examination isthe effective diagnostic method for PCNSL.3．After surgical removal of the tumors, the patients received whole brain radiotherapy, high dose methotrexate, and combined high dosemethotrexate with whole brain radiotherapy, median survival times are22,25and30months, respectively. After operation, the patients had none of anychemotherapy and radiotherapy, median survival times are4.5months only.4．The prognosis of patients with PCNSL is significantly associatedwith the therapeutic program (P<0.05). After surgical removal of the tumors,the combination of high dose methotrexate with whole brain radiotherapy canmarkedly improve survival of the patients with PCNSL.