Background/Objectives: Primary central nervous system lymphoma (PCNSL) is a rare but aggressive tumor, primarily affecting elderly patients. Radiotherapy (RT) remains an important treatment option, particularly for patients who are ineligible for systemic chemotherapy. This study aims to identify prognostic factors and evaluate recurrence patterns in a real-world cohort of PCNSL patients treated with RT.Methods: We retrospectively analyzed 64 PCNSL patients treated with radiotherapy at our institution between 2000 and 2022. Clinical characteristics, treatment details, and outcomes were collected by chart review. Overall survival (OS) was analyzed using Kaplan–Meier and Cox regression methods. Recurrence patterns were assessed based on available post-treatment imaging.Results: Median patient age was 71 years (range: 31–83); 53.1% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2. Radiotherapy was used as first-line treatment in 62.5% of cases, primarily due to contraindications to chemotherapy. Median OS was 10 months from diagnosis. Age, poor performance status, seizures at presentation, absence of systemic therapy, incomplete radiotherapy, and <80% applied dose of planned radiotherapy were associated with inferior OS in our univariable analysis. Multivariable analysis confirmed age, systemic therapy, seizures, and radiotherapy dose <80% as independent predictors. Among twenty-nine patients with imaging follow-up, eight recurrences after RT were documented: six of those within, and two outside of the initially affected areas. All recurrences occurred within previously irradiated areas.Conclusions: This study confirms known negative prognostic factors in PCNSL and underscores the importance of systemic chemotherapy for curatively intended treatments aiming for prolonged survival. The recurrence patterns observed question the added benefit of whole-brain irradiation in preventing distant relapses. These findings support the need for prospective trials to optimize radiotherapy strategies while balancing efficacy and neurotoxicity.
**背景/目的：** 原发性中枢神经系统淋巴瘤是一种罕见但侵袭性强的肿瘤，主要影响老年患者。放射治疗仍然是重要的治疗选择，尤其适用于不适合全身化疗的患者。本研究旨在确定接受放疗的PCNSL患者真实世界队列的预后因素，并评估其复发模式。 **方法：** 我们回顾性分析了2000年至2022年间在我院接受放疗的64例PCNSL患者。通过病历审查收集临床特征、治疗细节和结局。采用Kaplan-Meier法和Cox回归分析总生存期。根据可获得的治疗后影像学资料评估复发模式。 **结果：** 患者中位年龄为71岁（范围：31-83岁）；53.1%的患者东部肿瘤协作组体能状态评分≥2。62.5%的病例将放疗作为一线治疗，主要原因是存在化疗禁忌症。自诊断起的中位OS为10个月。在我们的单变量分析中，年龄、体能状态差、就诊时癫痫发作、未接受全身治疗、放疗未完成以及实际放疗剂量低于计划剂量的80%与较差的OS相关。多变量分析证实，年龄、全身治疗、癫痫发作以及放疗剂量<80%是独立的预测因素。在29例有影像学随访的患者中，记录了8例放疗后复发：其中6例在初始受累区域内复发，2例在区域外复发。所有复发均发生在先前照射过的区域内。 **结论：** 本研究证实了PCNSL已知的负面预后因素，并强调了旨在延长生存期的根治性治疗中全身化疗的重要性。观察到的复发模式对全脑照射在预防远处复发方面的额外获益提出了质疑。这些发现支持需要进行前瞻性试验，以在平衡疗效和神经毒性的同时优化放疗策略。
肿瘤(癌症)患者之家