Intensive chemoimmunotherapy and bilateral globe irradiation as initial therapy for primary intraocular lymphoma

• Published in: Neuro-oncology (Charlottesville, Va.) Vol. 18; no. 4; pp. 575 - 581
• Main Authors: Cheah, Chan Yoon, Milgrom, Sarah, Chihara, Dai, Gombos, Dan S, Pinnix, Chelsea C, Dabaja, Bouthaina S, Fowler, Nathan H
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-04-2016
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brain Neoplasms - pathology; Brain Neoplasms - therapy; Clinical Investigations; Combined Modality Therapy; Cranial Irradiation; Cytarabine - administration & dosage; Female; Follow-Up Studies; Humans; Immunotherapy; Intraocular Lymphoma - pathology; Intraocular Lymphoma - therapy; Male; Methotrexate - administration & dosage; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Procarbazine - administration & dosage; Prognosis; Remission Induction; Retrospective Studies; Salvage Therapy; Survival Rate; Vincristine - administration & dosage; primary intraocular lymphoma; radiotherapy; treatment; methotrexate; primary central nervous system lymphoma
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/nov253

Primary intraocular lymphoma is a rare variant of primary CNS lymphoma for which the optimum treatment strategy remains unknown.
We performed a retrospective single-center study including patients who underwent uniform management from October 2007 in which patients were offered sequential rituximab, methotrexate, procarbazine, and vincristine (R-MPV) followed by binocular radiotherapy and consolidative high-dose cytarabine.
Eleven patients with median age 66 years (range, 48-72) were included. All patients received binocular radiotherapy to a median dose of 36 Gy (range, 30.6-39.6) in 20 fractions. Grade 3+ anemia, thrombocytopenia, and neutropenia occurred in 1 (9%), 2 (18%), and 3 (27%) patients, respectively; raised creatinine and peripheral sensory neuropathy occurred in 4 (36%) and 3 (27%) patients, respectively. Grade 3+ ocular toxicities included cataract formation and keratitis in 6 (54%) and 3 (27%) patients, respectively. Ten patients (91%) achieved complete response and 1 (9%) partial response. After median follow-up of 4.2 years (range, 1.8-7.6), the median progression-free survival was 3.8 years and the estimated 4-year overall survival was 75.8% (95% CI: 30.5%-93.7%). The initial site of disease progression was the CNS in 4 of 7 patients (57%) and within the eye in 3 of 7 (43%). Five patients achieved responses to salvage therapies.
Combined modality treatment with R-MPV, binocular radiation, and high-dose cytarabine is effective with moderate toxicity. Both local and CNS relapses occur; however, the achievement of second and subsequent remissions is possible.