Neurological Surgery 脳神経外科46巻7号

2018年07月発行

研究

ESHAP二次化学療法の再発中枢神経系原発悪性リンパ腫に対する後方視的検討

著者： 長尾景充¹ 中村大志¹ 立石健祐¹ 佐藤秀光² 清水信行¹ 末永潤¹ 村田英俊¹ 菅野洋³ 山本哲哉¹

所属機関： ¹横浜市立大学大学院医学研究科脳神経外科学 ²神奈川県立がんセンター脳神経外科 ³国際医療福祉大学熱海病院脳神経外科

ページ範囲：P.575 - P.581

Ⅰ．はじめに
　中枢神経系原発悪性リンパ腫（primary central nervous system lymphoma：PCNSL）は，免疫不全を伴わない状態において中枢神経系組織に限局して発症したびまん性大細胞型B細胞リンパ腫（diffuse large B-cell lymphoma：DLBCL），と定義される¹⁴⁾．PCNSLは全原発性脳腫瘍の4.6%を占め，その頻度は本邦を含む先進国において近年増加傾向にある¹³⁾．標準治療として，生検による組織像の診断後に大量メトトレキサート（high-dose methotrexate：HD-MTX）を基盤とする化学療法を先行し，続いて全脳照射が施行されているものの，その予後は40〜55カ月と不良である^10,13,15)．また再発時における標準治療については未だ確立しておらず，現在さまざまな治療が試みられている．当院では，HD-MTX療法後の再発症例に対して，大量シタラビン（HD-AraC：2,000mg），シスプラチン（CDDP：25mg/m²），エトポシド（VP-16：40mg/m²），メチルプレドニゾロン（methylprednisolone：500mg）を用いた化学療法（以下，ESHAP療法）を施行している．今回われわれは，二次化学療法としてのESHAP療法の治療効果について検討を行った．

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