Résumé
The authors investigated objective response rate to high dose methotrexate (HDMTX)-based combination chemotherapy in primary central nervous system lymphoma (PCNSL), and sought to identify factors that influence response to HDMTX-based combination therapy. Prospective observational analysis was performed on 52 PCNSL patients. All patients received HDMTX (3.5 g/m2) and vincristine (1.4 mg/m2/day) for one day during weeks 1, 3, 5, 7, and 9, and procarbazine (100 mg/m2/day) for one week during weeks 1, 5, and 9. Forty-one patients (78.8%) achieved complete or partial remission. Higher objective response rates were observed for patients with: 1) age < 60 yr; 2) Eastern Cooperative Oncology Group (ECOG) performance score of < 2; 3) low risk status as defined by the International Extranodal Lymphoma Study Group; 4) p53 positivity; 5) XBP-1 negativity; 6) MUM-1 negativity; and 7) homogenous gadolinium enhancement in MR images. Multivariate analysis showed that ECOG performance score of < 2, low risk, negativity for XBP-1, homogenous gadolinium enhancement by MRI, and response to chemotherapy were associated with longer overall survival. In particular, it is interesting to note that patients with a PCNSL that is homogenously enhanced by gadolinium have a higher objective response rate, and a longer progression-free survival and overall survival.
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Facteurs âges , Protocoles de polychimiothérapie antinéoplasique/usage thérapeutique , Tumeurs du système nerveux central/traitement médicamenteux , Produits de contraste/composition chimique , Protéines de liaison à l'ADN/métabolisme , Survie sans rechute , Calendrier d'administration des médicaments , Études de suivi , Gadolinium/composition chimique , Facteurs de régulation d'interféron/métabolisme , Lymphomes/traitement médicamenteux , Imagerie par résonance magnétique , Méthotrexate/administration et posologie , Odds ratio , Procarbazine/administration et posologie , Études prospectives , Récidive , Indice de gravité de la maladie , Facteurs de transcription/métabolisme , Protéine p53 suppresseur de tumeur/métabolisme , Vincristine/administration et posologieRésumé
Spinal epidural abscess (SEA) is a rare infection but may be devastating and fatal. We describe a case of a42-year-old male who presented with a posteriorly located SEA extending from C2 to the sacrum with severe neurologic deficits. We had the emergency surgery with the minimal invasive technique using epidural irrigation catheter, and then obtained an excellent recovery. The purpose of this report introduces the usefulness of minimal invasive surgical technique for extensive SEA.