原发中枢神经系统淋巴瘤诊疗进展

摘要

原发中枢神经系统淋巴瘤是一种少见的中枢神经系统恶性肿瘤,以大剂量甲氨蝶呤为基础方案诱导化疗是目前一线治疗,随后全脑放疗作为巩固治疗.迟发神经认知功能障碍出现,尤其是老年人,使缓解患者是否需要全脑放疗或减量放疗需要进一步明确.利妥昔单抗治疗PCNSL,初步研究表明美罗华可能给患者带来获益,但研究证据水平较低.HDC/ASCT对于治疗复发性或难治性PCNSL虽有疗效但毒副作用较大,临床价值尚存争议.%Primary central nervous system lymphoma(PCNSL) is a rare CNS tumor,and its optimal management is a matter of controversy.High-dose MTX-based polychemotherapy is recommended as a first-line treatment,with followed WBRT consolidated.With WBRT for consolidation delayed neurotoxicity in elderly patients,WBRT may be deferred until relapse or dose-reduced WBRT are encouraging.High-dose methotrexate with or without rituximab is currently investigated in ongoing randomized trials.Intensive chemotherapy with HDC/ASCT is a therapeutic option in relapsing PCNSL.