Primary CNS lymphoma in patients younger than 60: Can whole-brain radiotherapy be deferred? Journal Article

Authors: Omuro, A.; Taillandier, L.; Chinot, O.; Sierra Del Rio, M.; Carnin, C.; Barrie, M.; Soussain, C.; Tanguy, M. L.; Choquet, S.; Leblond, V.; Hoang-Xuan, K.
Article Title: Primary CNS lymphoma in patients younger than 60: Can whole-brain radiotherapy be deferred?
Abstract: Whole brain radiotherapy (WBRT) has been increasingly omitted as the first treatment of primary central nervous system lymphoma (PCNSL) because of neurotoxicity risks. However, neurotoxicity risks are lower in young (<60 years) patients; deferring WBRT may not be necessary and may compromise disease control. To investigate this question, we report a consecutive series of young (<60 years) PCNSL patients uniformly treated with a response-adjusted approach, with WBRT omitted in patients with chemosensitive disease. Treatment started with induction chemotherapy consisting of methotrexate (3 g/m 2), CCNU, procarbazine, methylprednisolone and intrathecal methotrexate, cytarabine, and methylprednisolone. Patients achieving complete response (CR) received five additional chemotherapy cycles and no further treatment. Patients with less than CR were treated on an individual basis, typically with WBRT or high-dose chemotherapy (HDC) with stem cell rescue. Sixty-four patients were included (median age: 47; median KPS: 70). Median progression-free survival (PFS) was 12 months; median overall survival (OS) was 63 months (median follow-up: 108 months). Objective response after induction was 87% (CR: 54%; PR: 33%). To date, salvage WBRT has been given to a total of 27 patients and HDC to 29. Neurotoxicity developed in five patients (none in patients treated with chemotherapy only). Deferring WBRT in chemosensitive patients seems to compromise PFS but not OS. Neurotoxicity was reduced but not eliminated, as salvage WBRT was frequently required. HDC and WBRT were effective salvage treatments. As the objective of treatment in this population is a cure, withholding WBRT may not be the best strategy and deserves further investigation. Ongoing studies are investigating whether upfront treatment with HDC can replace WBRT in this setting. © 2010 Springer Science+Business Media, LLC.
Keywords: adult; treatment response; disease-free survival; middle aged; young adult; major clinical study; overall survival; busulfan; neutropenia; salvage therapy; cancer combination chemotherapy; treatment planning; chemotherapy; primary central nervous system lymphoma; cytarabine; methotrexate; temozolomide; brain radiation; drug megadose; neurotoxicity; outcome assessment; follow up; progression free survival; drug eruption; multiple cycle treatment; nephrotoxicity; anemia; etoposide; leukopenia; lung disease; mucosa inflammation; thrombocytopenia; proportional hazards models; radiotherapy; cyclophosphamide; autologous stem cell transplantation; chemosensitivity; medical record review; ifosfamide; lomustine; procarbazine; thiotepa; central nervous system neoplasms; febrile neutropenia; hyperglycemia; lymphocytopenia; confidence intervals; hyponatremia; survival time; karnofsky performance status; brain; lymphoma; brain disease; methylprednisolone; idarubicin; drug therapy; treatment refusal; spinal cord disease; whole brain radiotherapy; epileptic state; septic shock; brain abscess; optic nerve disease
Journal Title: Journal of Neuro-Oncology
Volume: 104
Issue: 1
ISSN: 0167-594X
Publisher: Springer  
Date Published: 2011-08-01
Start Page: 323
End Page: 330
Language: English
DOI: 10.1007/s11060-010-0497-x
PROVIDER: scopus
PUBMED: 21170569
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 3 October 2011" - "CODEN: JNODD" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Antonio Marcilio Padula Omuro
    195 Omuro