Combined-modality therapy for primary central nervous system lymphoma: long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group)

• Published in: International journal of radiation oncology, biology, physics Vol. 64; no. 2; p. 408
• Main Authors: O'Brien, Peter C, Roos, Daniel E, Pratt, Gary, Liew, K-H, Barton, Michael B, Poulsen, Michael G, Olver, Ian N, Trotter, Grant E
• Format: Journal Article
• Language: English
• Published: United States 01-02-2006
• Subjects: Adult; Age Factors; Aged; Antimetabolites, Antineoplastic - therapeutic use; Ataxia - etiology; Ataxia - mortality; Central Nervous System Neoplasms - drug therapy; Central Nervous System Neoplasms - mortality; Central Nervous System Neoplasms - radiotherapy; Combined Modality Therapy; Cranial Irradiation - adverse effects; Cranial Irradiation - methods; Humans; Lymphoma - drug therapy; Lymphoma - mortality; Lymphoma - radiotherapy; Methotrexate - therapeutic use; Middle Aged
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2005.07.958

To assess, in a multicenter setting, the long-term outcomes of a brief course of high-dose methotrexate followed by radiotherapy for patients with primary central nervous system lymphoma (PCNSL).
Forty-six patients were entered in a Phase II protocol consisting of methotrexate (1 g/m(2) on Days 1 and 8), followed by whole-brain irradiation (45-50.4 Gy). The median follow-up time was 7 years, with a minimum follow-up of 5 years.
The 5-year survival estimate was 37% (+/-14%, 95% confidence interval [CI]), with progression-free survival being 36% (+/-15%, 95% CI), and median survival 36 months. Of the original 46 patients, 10 were alive, all without evidence of disease recurrence. A total of 11 patients have developed neurotoxicity, with the actuarial risk being 30% (+/-18%, 95% CI) at 5 years but continuing to increase. For patients aged>60 years the risk of neurotoxicity at 7 years was 58% (+/-30%, 95% CI).
Combined-modality therapy, based on high-dose methotrexate, results in improved survival outcomes in PCNSL. The risk of neurotoxicity for patients aged>60 years is unacceptable with this regimen, although survival outcomes for patients aged>60 years were higher than in many other series.