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題名 | Radiation Therapy in Primary Central Nervous System Lymphoma=放射治療中樞神經淋巴瘤之臨床經驗 |
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作者 | 陳惠君; 梁雲; 王重榮; 孫立民; 方富民; 黃英彥; 許軒之; 葉世安; 熊敬業; | 書刊名 | 長庚醫學 |
卷期 | 22:1 1999.03[民88.03] |
頁次 | 頁88-93 |
分類號 | 415.6 |
關鍵詞 | 中樞神經淋巴瘤; 放射治療; 化學治療; Primary central nervous system lymphoma; PCNSL; Radiotherapy; Chemotherapy; |
語文 | 英文(English) |
中文摘要 | 背景:原發性中樞神經淋巴瘤為一少見之腫瘤。文獻上關於中國人中樞神經淋巴 瘤之治療並不多見,故於此提出高雄長庚醫院治療此一腫瘤之臨床經驗。 方法:我們分析從1988年到1997年在高雄長庚醫院放射腫瘤科接受治療之13位病患。病患資 料、臨床症狀、治療方法、治療結果及復發型態均加以整理分析。 結果:13位經診斷為中樞神經淋巴瘤之病患中,10位為腦淋巴瘤,3位為脊髓淋巴瘤,男╱ 女性比例為 7 ╱ 6,平均年齡為 54.9 ± 13.1 歲。 在細胞型態上以擴散性大細胞淋巴瘤 (佔 10 位)最為常見。 而肢體無力(佔 11 位)及頭痛(佔 7 位)為最常見之臨床表徵 。 在治療方式之分析中,4 位病患接受手術全切除,8 位部份切除及 1 位只接受切片檢查 ;爾後,9 位病患接受放射治療,而其他 4 位病患接受合併放射治療及化學治療。10 位腦 淋巴瘤病患接受全腦放射治療之劑量在 36 ∼ 58 格雷及局部加強照射 6 ∼ 16 格雷。 所 有病患都接受治療後之電腦斷層檢查, 其中 9 位( 69 %)病患達到影像上腫瘤完全緩解 ,而 4 位病患達部份緩解。而在症狀改善方面,9 位病患於治療後可恢復正常活動。 9 位 只接受放射治療之病患中有 5 位發生復發,而 4 位接受合併放射治療及化學治療之病患中 有 1 位發生復發。 平均存活時間為 24.4 個月, 兩年存活率為 54 %,而 5 年存活率為 27 %。 結論:對於中樞神經淋巴瘤之病患,縱使放射治療之緩解率相當高,但半數以上之病患於治 療後仍容易復發。因此,日後對於此類病患之治療應以三度空間順形放射治療來進一步提高 放射劑量,或合併放射治療及化學治療來提高局部控制率。 |
英文摘要 | Background: Treatment of primary central nervous system lymphoma (PCNSL) in Chinese individuals had rarely been reported. Therefore, this article presents our experience in managing PCNSL with radiotherapy. Methods: A thorough review was made of the medical records of 13 patients diagnosed with PCNSL at Kaohsiung Chang Gung Memorial Hospital from 1988 through 1997. The clinical characteristics, treatment modalities, and results were analyzed as well. Results: Thirteen patients diagnosed with PCNSL were identified, of which 10 cases origintated in the brain whereas three were of spinal origin. Seven of the patients were man and six were women, with a mean age of 54.9 ± 13.1 years (range 29 to 74 years). Diffuse large cell lymphoma (11 cases) was the most common histology. Limb weakness (11 cases) and headache (7 cases) were the most common complaints at presentation. Nine patients received radiation therapy alone and four patients received radiation therapy plus chemotherapy after surgical resection or biopsy. Follow-up computed tomography (CT) scans 3 to 4 months after the completion of radiotherapy revealed that nine patients (69%) had a complete response and four (31%) had a partial response. Local recurrence occurred in five patients (56%) treated with radiation therapy alone and in one patient (25%) treated with combined modalities. The overall actuarial survival rate was 54% at 2 years and 27% at 5 years. Conclusion: Results in this study indicate that the initial response to radiotherapy is satisfactory. However, a local relapse frequently occurs. Future considerations should focus on new modes of treatment, such as three-dimentional conformal radiation therapy for dose escalation or a combination of chemotherapy and radiotherapy. |
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