Long-term survival following radiotherapy and cytarabine chemotherapy for sporadic primary central nervous system lymphoma

To analyze the long-term results following whole brain radiotherapy (WBRT) with sequential intrathecal (i.th.) cytosine arabinoside (Ara-C) +/- intravenous (i.v.) Ara-C in patients with primary central nervous system lymphoma (PCNSL). 14 patients were treated between July 1987 and August 1995. All h...

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Published in:	Strahlentherapie und Onkologie Vol. 179; no. 9; pp. 626 - 632
Main Authors:	PÖTTGEN, Christoph, STUSCHKE, Martin, FEHLINGS, Thorsten, STÜBEN, Georg, SCHMITZ, Armin, SCHWECHHEIMER, Karl, WACKER, Hans-Heinrich, RAUHUT, Friedhelm, KLEUKER, Susanne, WILHELM, Hans, GREHL, Sara
Format:	Journal Article
Language:	English
Published:	München Springer 01-09-2003 Springer Nature B.V
Subjects:	Adult Aged Antimetabolites, Antineoplastic - administration & dosage Antimetabolites, Antineoplastic - therapeutic use Antineoplastic agents Biological and medical sciences Brain Neoplasms - drug therapy Brain Neoplasms - mortality Brain Neoplasms - radiotherapy Brain Neoplasms - therapy Cause of Death Chemotherapy Combined Modality Therapy Combined treatments (chemotherapy of immunotherapy associated with an other treatment) Confidence Intervals Cytarabine - administration & dosage Cytarabine - therapeutic use Dose Fractionation Female Follow-Up Studies Humans Injections, Intravenous Injections, Spinal Lymphoma Lymphoma - drug therapy Lymphoma - mortality Lymphoma - radiotherapy Lymphoma - therapy Lymphoma, B-Cell - drug therapy Lymphoma, B-Cell - mortality Lymphoma, B-Cell - radiotherapy Lymphoma, Large B-Cell, Diffuse - drug therapy Lymphoma, Large B-Cell, Diffuse - mortality Lymphoma, Large B-Cell, Diffuse - radiotherapy Lymphoma, Large-Cell, Anaplastic - drug therapy Lymphoma, Large-Cell, Anaplastic - mortality Lymphoma, Large-Cell, Anaplastic - radiotherapy Lymphoma, T-Cell - drug therapy Lymphoma, T-Cell - mortality Lymphoma, T-Cell - radiotherapy Male Medical sciences Middle Aged Ovarian cancer Pharmacology. Drug treatments Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality Precursor Cell Lymphoblastic Leukemia-Lymphoma - radiotherapy Radiation therapy Radiotherapy Dosage Survival Analysis Time Factors Antineoplastic agent Human Primary CNS lymphoma Nervous system diseases Cytosine arabinoside Prognosis Sporadic Central nervous system Malignant hemopathy Non Hodgkin lymphoma Radiotherapy Long term Chemotherapy Cytarabine Antimetabolic Lymphoproliferative syndrome Central nervous system disease Combined treatment Pyrimidine nucleoside Whole brain radiotherapy
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Summary:	To analyze the long-term results following whole brain radiotherapy (WBRT) with sequential intrathecal (i.th.) cytosine arabinoside (Ara-C) +/- intravenous (i.v.) Ara-C in patients with primary central nervous system lymphoma (PCNSL). 14 patients were treated between July 1987 and August 1995. All had sporadic PCNSL with proven histology of high-grade CNS lymphoma (twelve diffuse large-cell B-lymphomas, one lymphoblastic lymphoma, one large T-cell lymphoma). Patients were treated with two to four cycles of induction chemotherapy (40 mg/m2 Ara-C i.th.), four patients received additional Ara-C i.v. (150 mg/m2, d1-4). WBRT was administered using 1.8-Gy fractions. Intrathecal chemotherapy was planned afterwards in 4-week intervals for 6 months. Posttreatment neurocognitive evaluations were performed in two long-term survivors. Two of four patients who received i.v. and i.th. induction chemotherapy showed progressive disease, and irradiation was started immediately. Six of 14 patients received 50.4 Gy WBRT, four patients had WBRT up to 39.6 Gy followed by a 10.8-Gy boost. Five patients died early during therapy either due to a decline of the general medical condition or progressive disease. Median survival was 41 months (95% confidence interval: 6-79 months), survival at 3 and 5 years was 59% and 42%, respectively. Six patients survived for 3 years, two younger patients are still alive (> 12 years). They show only slightly impaired neurocognitive functions without clinical relevance. This WBRT-based protocol with i.th. meningeal prophylaxis using Ara-C +/- i.v. Ara-C yields substantial long-term survival with moderate toxicity. The value of i.v. chemotherapy is currently being investigated in prospective studies.
ISSN:	0179-7158 1439-099X
DOI:	10.1007/s00066-003-1083-3