Low-dose and limited-volume radiotherapy alone for primary dural marginal zone lymphoma: Treatment approach and review of published data Journal Article
| Authors: | Puri, D. R.; Tereffe, W.; Yahalom, J. |
| Article Title: | Low-dose and limited-volume radiotherapy alone for primary dural marginal zone lymphoma: Treatment approach and review of published data |
| Abstract: | Purpose: Primary dural lymphoma is a rare intracranial lymphoma that almost always has a marginal zone histologic type and immunophenotype and often remains localized and is thus potentially curable with radiotherapy (RT) alone. The unusual location and histologic type of primary dural marginal zone lymphoma (PDMZL) distinguish it from primary central nervous system lymphoma and poses treatment dilemmas of technique, volume, and dose that have not been well addressed. We set out to analyze our recent experience in treating PDMZL and reviewed the limited published data available. Methods and Materials: Between 2002 and 2006, we treated 5 patients with localized PDMZL. Of these 5 patients, 3 had unilateral and 2 had bilateral/multifocal involvement, and 3 underwent subtotal tumor resection and 2 biopsy only. Whole brain RT was given before involved-field RT (IFRT) in 4 patients and 1 received IFRT alone. The median whole brain RT, IFRT, and total RT dose was 20, 12, and 30 Gy, respectively. The planning computed tomography scan was always fused with the post-gadolinium magnetic resonance imaging scan to assist in the IFRT volume determination. We also analyzed the published data from 27 additional patients. Results: The median follow-up was 34 months (range, 31-52). All obtained lasting local control. One patient developed a relapse in the soft tissue of the flank and additional systemic progression but no central nervous system recurrence. At last follow-up, no significant treatment-related neurotoxicity was detected. Conclusion: The results of our study have demonstrated that a combination of whole brain RT/IFRT or even low-dose IFRT alone provides excellent durable local control of PDMZL. This approach is potentially curative, possibly without significant neurotoxicity. Additional study and longer follow-up are needed to determine the appropriate RT dose and volume parameters for this rare, debilitating, and yet potentially curable lymphoma. © 2008 Elsevier Inc. All rights reserved. |
| Keywords: | adult; clinical article; controlled study; human tissue; treatment outcome; middle aged; cancer surgery; fludarabine; histopathology; cancer localization; cancer recurrence; doxorubicin; cancer growth; monotherapy; cancer radiotherapy; radiation dose; cytarabine; gadolinium; methotrexate; rituximab; neurotoxicity; nuclear magnetic resonance imaging; positron emission tomography; follow up; brain neoplasms; magnetic resonance imaging; computer assisted tomography; radiotherapy dosage; radiotherapy; tomography, x-ray computed; vincristine; ifosfamide; lomustine; procarbazine; central nervous system; pneumonia; meningeal neoplasms; computerized tomography; diagnostic radiography; medical imaging; tomography; folinic acid; lymphoma; sepsis; cancer relapse; immunophenotyping; headache; local control; disease control; resonance; dura mater; neurology; imaging techniques; marginal zone; electrotherapeutics; radiotherapy alone; lymphoma, b-cell, marginal zone; dura; involved field; malt; mucosa-associated lymphoid tissue; computed tomography scans; immunophenotype; low-dose; soft tissues; tumor resection; volume determination; volume parameters; primary dural lymphoma |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 71 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-08-01 |
| Start Page: | 1425 |
| End Page: | 1435 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2007.12.007 |
| PUBMED: | 18234430 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 5" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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