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Long-term survival following radiotherapy and cytarabine chemotherapy for sporadic primary central nervous system lymphoma.
- Source :
-
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] [Strahlenther Onkol] 2003 Sep; Vol. 179 (9), pp. 626-32. - Publication Year :
- 2003
-
Abstract
- Purpose: 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).<br />Patients and Methods: 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.<br />Results: 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.<br />Conclusion: 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.
- Subjects :
- Adult
Aged
Antimetabolites, Antineoplastic administration & dosage
Brain Neoplasms drug therapy
Brain Neoplasms radiotherapy
Cause of Death
Combined Modality Therapy
Confidence Intervals
Cytarabine administration & dosage
Dose Fractionation, Radiation
Female
Follow-Up Studies
Humans
Injections, Intravenous
Injections, Spinal
Lymphoma drug therapy
Lymphoma radiotherapy
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
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma radiotherapy
Radiotherapy Dosage
Survival Analysis
Time Factors
Antimetabolites, Antineoplastic therapeutic use
Brain Neoplasms mortality
Brain Neoplasms therapy
Cytarabine therapeutic use
Lymphoma mortality
Lymphoma therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0179-7158
- Volume :
- 179
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]
- Publication Type :
- Academic Journal
- Accession number :
- 14628129
- Full Text :
- https://doi.org/10.1007/s00066-003-1083-3