原发性中枢神经系统淋巴瘤9例临床分析(1)
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【摘要】 目的 探讨原发性中枢神经系统淋巴瘤的早期诊断方法及综合治疗疗效观察。方法 对经病理及免疫组化证实的9例原发性中枢神经系统淋巴瘤患者均行放化疗治疗。结果 经综合治疗后CR 5例,PR 2例,NC 1例,PD 1例。9例均得到有效随访,1例生存5个月后死亡;1例18个月后肿瘤复发。本组9例存活时间最短5个月,最长5年3个月,平均生存时间38个月。3年总存活率为78%,5年生存率44%。结论 对病理诊断明确的PCNSL患者,进行以放疗为主、辅以全身静脉化疗的综合治疗,可以明显改善临床症状、延长生存期,提高生活质量。
【关键词】中枢神经系统淋巴瘤;放疗;化疗
Clinical analysis of 9 patients with primary central nervous system lymphoma
LI Bo,ZHAO Yong-Li,ZHANG Jing-hui,et al.Department of radiotherapy,the Central Hospital of Jiaozhou,Qingdao 266300,China
【Abstract】 Objective To investigate the early diagnosis and comprehensive observation on therapeutic effect of primary central nervous system lymphoma.Methods All the 9 patients with primary central nervous system lymphoma diagnosed by pathology and immunohistochemistry were received radiotherapy and chemotherapy.Results The Completed release was found in 5 patients,partial response in 2 patients,stable disease in 1 patient and progressive disease in 1 patient.All the 9 patients in the group were followed up sufficiently.One patient died after five months,and tumor recurrence in one patient after eighteen months.The shortest survival time of the 9 patients in the group was five months,the longest was five years and three months,and the average survival time was 38 months.3-year survival rate was 78%,and 5-year survival rate was 44%.Conclusion The treatment of radiotherapy with assisted chemotherapy for patients with primary central nervous system lymphoma diagnosed by pathology could improve clinical symptoms,prolong survival time and improve life quality.
【Key words】Primary central nervous system lymphoma; Radiotherapy; Chemotherapy
原发性中枢神经系统淋巴瘤(primary central nervous system lymphomas,PCNSL)是一类罕见的中枢神经系统肿瘤,占恶性淋巴瘤的1%~2%,中枢神经系统恶性肿瘤的5%[1]。近年来,其发病率不仅在获得性免疫系统缺陷综合征等免疫缺陷的患者中逐步增加,而且在免疫功能正常的人群中也明显增加。PCNSL大多是B细胞来源,进展很快,临床极易造成误诊。本研究通过回顾性分析我院2000~2005年收治的9例PCNSL患者,探讨早期诊断经验及综合治疗PCNSL的疗效观察。
1 资料和方法
1.1 一般资料 本组9例中男6例,女3例,年龄45~63岁,平均年龄54岁。临床主要表现:颅内压增高引起的头痛、恶心、呕吐;病灶占位引起的颅神经损伤、偏瘫及精神症状如情感障碍、记忆力下降等。病程7 d~6个月,平均33 d。既往均无免疫性疾病病史,均未接受过免疫抑制药物及放射治疗,均无获得性免疫缺陷综合征(AIDS)的临床表现。所有患者均经病理组织学及免疫组化检查证实为淋巴瘤(8例为B细胞型淋巴瘤,1例为T细胞型)。
1.2 影像学资料 所有病例均常规行头颅CT及MRI检查。病变为单病灶7例,多病灶2例,其中1例2个病灶另1例3个病灶;圆形或类圆形病灶4个,不规则形8个。单发位于额叶3例,顶叶2例,颞叶1例,左小脑1例;多病灶左额叶-胼胝体膝-1例,左基底节区-左丘脑-左中脑1例。 CT平扫示等密度或略高密度实性病灶,周围均有不同程度水肿区,增强后呈明显均匀强化。MRI表现:在T1WI上,低信号病灶4例,稍低信号2例,高信号3例,病灶周围水肿为低信号;T2WI病灶呈稍低信号5例,高信号2例,等信号2例,病灶周围水肿为高信号 ......
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