Neurological Surgery 脳神経外科44巻7号

2016年07月発行

連載 脳腫瘍Update

（8）Primary central nervous system lymphoma（中枢神経系原発悪性リンパ腫）

著者： 中村英夫¹

所属機関： ¹熊本大学脳神経外科

ページ範囲：P.605 - P.611

Ⅰ．はじめに
　中枢神経原発悪性リンパ腫（primary central nervous system lymphoma：PCNSL）は節外性リンパ腫の1つであり，近年，特に高齢者において発生頻度が増加しているといわれている．PCNSLと一般臓器に発生したリンパ腫が二次性に頭蓋内に進展（転移）したものとは鑑別可能であるが，治療に関しては，中枢神経系に進展している場合，他臓器のリンパ腫の治療だけでは有効でないことが多い．大量メトトレキサート（high-dose methotrexate：HD-MTX）療法がPCNSLのスタンダードな治療となってから10年以上経過し，治療成績が多くの施設から報告されているが，5年生存率はまだ高くないといわざるを得ない．本稿では，PCNSLの最新の報告をまとめる．

参考文献

1) Abrey LE, Moskowitz CH, Mason WP, Crump M, Stewart D, Forsyth P, Paleologos N, Correa DD, Anderson ND, Caron D, Zelenetz A, Nimer SD, DeAngelis LM：Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma：an intent-to-treat analysis. J Clin Oncol 21：4151-4156, 2003

2) Batchelor T, Carson K, O'Neill A, Grossman SA, Alavi J, New P, Hochberg F, Priet R：Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy：a report of NABTT 96-07. J Clin Oncol 21：1044-1049, 2003

3) Cady FM, O'Neill BP, Law ME, Decker PA, Kurtz DM, Giannini C, Porter AB, Kurtin PJ, Johnston PB, Dogan A, Remstein ED：Del（6）（q22）and BCL6 rearrangements in primary CNS lymphoma are indicators of an aggressive clinical course. J Clin Oncol 26：4814-4819, 2008

4) Deckert M, Montesinos-Rongen M, Brunn A, Siebert R：Systems biology of primary CNS lymphoma：from genetic aberrations to modeling in mice. Acta Neuropathol 127：175-188, 2014

5) DeAngelis LM, Seiferheld W, Schold SC, Fisher B, Schultz CJ；Radiation Therapy Oncology Group Study 93-10：Combination chemotherapy and radiotherapy for primary central nervous system lymphoma：Radiation Therapy Oncology Group Study 93-10. J Clin Oncol 20：4643-4648, 2002

6) Illerhaus G, Marks R, Ihorst G, Guttenberger R, Ostertag C, Derigs G, Frickhofen N, Feuerhake F, Volk B, Finke J：High-dose chemotherapy with autologous stem-cell transplantation and hyperfractionated radiotherapy as first-line treatment of primary CNS lymphoma. J Clin Oncol 24：3865-3870, 2006

7) Klein U, Dalla-Favera R：Germinal centres：role in B-cell physiology and malignancy. Nat Rev Immunol 8：22-33, 2008

8) Laperriere NJ, Cerezo L, Milosevic MF, Wong CS, Patterson B, Panzarella T：Primary lymphoma of brain：results of management of a modern cohort with radiation therapy. Radiother Oncol 43：247-252, 1997

9) Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P：WHO Classification of Tumours of the Central Nervous System. IARC, Lyon, 2007, pp.188-192

10) Montesinos-Rongen M, Siebert R, Deckert M：Primary lymphoma of the central nervous system：just DLBCL or not? Blood 113：7-10, 2009

11) Nelson DF, Martz KL, Bonner H, Nelson JS, Newall J, Kerman HD, Thomson JW, Murray KJ：Non-Hodgkin's lymphoma of the brain：can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group（RTOG）：RTOG 8315. Int J Radiat Oncol Biol Phys 23：9-17, 1992

12) O'Brien P, Roos D, Pratt G, Liew K, Barton M, Poulsen M, Olver I, Trotter G：Phase Ⅱ multicenter study of brief single-agent methotrexate followed by irradiation in primary CNS lymphoma. J Clin Oncol 18：519-526, 2000

13) Ostrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, Wolinsky Y, Kruchko C, Barnholtz-Sloan J：CBTRUS statistical report：primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol 16（Suppl 4）：iv1-63, 2014

14) Reni M, Zaja F, Mason W, Perry J, Mazza E, Spina M, Bordonaro R, Ilariucci F, Faedi M, Corazzelli G, Manno P, Franceschi E, Pace A, Candela M, Abbadessa A, Stelitano C, Latte G, Ferreri AJ：Temozolomide as salvage treatment in primary brain lymphomas. Br J Cancer 96：864-867, 2007

15) Rubenstein JL, Hsi ED, Johnson JL, Jung SH, Nakashima MO, Grant B, Cheson BD, Kaplan LD：Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS lymphoma：CALGB 50202（Alliance 50202). J Clin Oncol 31：3061-3068, 2013

16) Schorb E, Kasenda B, Atta J, Kaun S, Morgner A, Hess G, Elter T, von Bubnoff N, Dreyling M, Ringhoffer M, Krause SW, Derigs G, Klimm B, Niemann D, Fritsch K, Finke J, Illerhaus G：Prognosis of patients with primary central nervous system lymphoma after high-dose chemotherapy followed by autologous stem cell transplantation. Haematologica 98：765-770, 2013

17) Shah GD, Yahalom J, Correa DD, Lai RK, Raizer JJ, Schiff D, LaRocca R, Grant B, DeAngelis LM, Abrey LE：Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 25：4730-4735, 2007

18) Shapiro WR, Young DF, Mehta BM：Methotrexate：distribution in cerebrospinal fluid after intravenous, ventricular and lumber injections. N Engl J Med 293：161-166, 1975

19) Shibamoto Y, Sumi M, Onodera S, Matsushita H, Sugie C, Tamaki Y, Onishi H, Abe E, Koizumi M, Miyawaki D, Kubota S, Ogo E, Nomiya T, Takemoto M, Harada H, Takahashi I, Ohmori Y, Ishibashi N, Tokumaru S, Suzuki K：Primary CNS lymphoma treated with radiotherapy in Japan：a survey of patients treated in 2005-2009 and a comparison with those treated in 1985-2004. Int J Clin Oncol 19：963-971, 2014

20) Thiel E, Korfel A, Martus P, Kanz L, Griesinger F, Rauch M, Röth A, Hertenstein B, von Toll T, Hundsberger T, Mergenthaler HG, Leithäuser M, Birnbaum T, Fischer L, Jahnke K, Herrlinger U, Plasswilm L, Nägele T, Pietsch T, Bamberg M, Weller M：High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma（G-PCNSL-SG-1）：a phase 3, randomised, non-inferiority trial. Lancet Oncol 11：1036-1047, 2010