原发中枢神经系统淋巴瘤患者接受放疗与替莫唑胺为主的化疗治疗效果
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摘要
目的:探讨原发中枢神经系统淋巴瘤(PCNSL)患者接受放疗与替莫唑胺为主的化疗治疗的效果。方法:按照是否接受放疗将43例PCNSL患者分为实验组(放疗+化疗) 24例和对照组(化疗) 19例,对照组仅接受以替莫唑胺为主的化疗,实验组患者接受同步放化疗治疗,比较两组患者治疗后近期疗效、外周血T淋巴细胞亚群、NK细胞含量,并记录治疗期间毒副反应及5年内患者总生存率(OS)和无进展生存率(PFS)。结果:实验组患者总有效率(RR)显著高于对照组,差异有统计学意义(P <0. 05);实验组患者治疗后CD3+、CD4+、CD4+/CD8+、NK细胞含量均显著高于对照组,CD8+水平显著低于对照组,差异有统计学意义(P <0. 05);实验组患者血液毒性反应、脱发和黏膜炎发生率均显著高于对照组,差异有统计学意义(P <0. 05);实验组患者1年、3年无进展生存率均显著高于对照组,中位生存时间显著长于对照组,差异具有统计学意义(P <0. 05)。结论:放疗联合替莫唑胺为主的化疗治疗PCNSL疗效显著,患者免疫治疗改善明显,远期生存率高,但部分毒副反应发生率有所增加。
Objective: To explore the clinical effects for the patients with primary central nervous system lymphoma by radiation and temozolomide. Methods: 43 cases of patients with PCNSL were randomly divided into experiment group(radiation +chemotherapy) and control group(chemotherapy). The clinical effects,peripheral blood T lymphocyte subsets,NK cell content,OS,PFS were compared. Results: The RR for the experiment group were higher than the control group(P < 0. 05); The CD3+,CD4+,CD4+/CD8+,NK for the experiment group were higher than the control group(P < 0. 05); the CD8+for the experiment group were lower than the control group(P < 0. 05); the rate of blood toxicity reaction,alopecia,mucositis for the experiment group were higher than the control group(P < 0. 05); the PFS for 1 year and 3 years for the experiment group were higher than the control group(P < 0. 05),the median survival time were longer than the control group(P < 0. 05). Conclusion: It has good clinical effects for the patients with primary central nervous system lymphoma by radiation and temozolomide,it can improve the immune function,with high rate of long term survival rate,it has high rate of side effect.
Objective: To explore the clinical effects for the patients with primary central nervous system lymphoma by radiation and temozolomide. Methods: 43 cases of patients with PCNSL were randomly divided into experiment group(radiation +chemotherapy) and control group(chemotherapy). The clinical effects,peripheral blood T lymphocyte subsets,NK cell content,OS,PFS were compared. Results: The RR for the experiment group were higher than the control group(P < 0. 05); The CD3+,CD4+,CD4+/CD8+,NK for the experiment group were higher than the control group(P < 0. 05); the CD8+for the experiment group were lower than the control group(P < 0. 05); the rate of blood toxicity reaction,alopecia,mucositis for the experiment group were higher than the control group(P < 0. 05); the PFS for 1 year and 3 years for the experiment group were higher than the control group(P < 0. 05),the median survival time were longer than the control group(P < 0. 05). Conclusion: It has good clinical effects for the patients with primary central nervous system lymphoma by radiation and temozolomide,it can improve the immune function,with high rate of long term survival rate,it has high rate of side effect.
引文
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[2]李宏业,徐军,周士振,等.替莫唑胺配合放疗治疗原发性中枢神经系统淋巴瘤的临床观察[J].中华肿瘤防治杂志,2010,17(12):937-939.
[3]丁江华.替莫唑胺一线治疗原发性中枢神经系统淋巴瘤完全缓解1例及文献复习[J].安徽医药,2011,15(12):1591-1592.
[4]王勇,岳晓,朱玉方,等.替莫唑胺为主的化疗联合放疗治疗原发中枢神经系统淋巴瘤的临床观察[J].中国肿瘤临床,2012,39(23):1930-1933.
[5]克晓燕.淋巴瘤诊疗手册[M].北京:人民卫生出版社,2010:198-199.
[6]马文斌,郭旭,王任直.美国NCCN神经系统肿瘤治疗指南(2008)的介绍及解读[J].中国神经精神疾病杂志,2009,35(6):323-326.
[7]刘鸿良,刘婷,马超,等.原发中枢神经系统淋巴瘤20例临床特点与预后分析[J].中国实验血液学杂志,2015,23(1):111.
[8]杨燕光,沈剑虹,蔡晶,等.原发性中枢神经系统淋巴瘤临床及预后分析[J].中华肿瘤防治杂志,2012,19(9):689-693.
[9]李志超,田增民.原发性中枢神经系统淋巴瘤的治疗进展[J].中国临床神经外科杂志,2012,17(11):695-698.
[10]Cordone I,Masi S,Carosi M,et al.Brain stereotactic biopsy flow cytometry for central nervous system lymphoma characterization:advantages and pitfalls[J].J Exp Clin Cancer Res,2016,35(1):128.
[11]Ravindra VM,Raheja A,Corn H,et al.Primary pituitary diffuse large B-cell lymphoma with somatotroph hyperplasia and acromegaly:case report[J].J Neurosurg,2016,8(12):1-6.
[12]Nitta N,Nakasu S,Shima A,et al.m TORC1 signaling in primary central nervous system lymphoma[J].Surg Neurol Int,2016,7(17):S475-S480.
[13]Sharma MC,Gupta RK,Kaushal S,et al.A clinicopathological study of primary central nervous system lymphomas&their association with Epstein-Barr virus[J].Indian J Med Res,2016,143(5):605-615.
[14]孙国涛,孙祥民,陶荣杰.替莫唑胺治疗原发性中枢神经系统淋巴瘤5例分析[J].慢性病学杂志,2010,12(11):1500.
[15]袁鹏,余正平,岳天华,等.伊达比星联合甲氨蝶呤治疗原发中枢神经系统弥漫大B细胞淋巴瘤的临床效果研究[J].中国实验血液学杂志,2014,22(6):1621-1623.
[16]Nabavizadeh SA,Vossough A,Hajmomenian M,et al.Neuroimaging in Central Nervous System Lymphoma[J].Hematol Oncol Clin North Am,2016,30(4):799-821.