Salvage whole brain radiotherapy for recurrent or refractory primary CNS lymphoma Journal Article

  


Authors: Hottinger, A. F.; Deangelis, L. M.; Yahalom, J.; Abrey, L. E.
Article Title: Salvage whole brain radiotherapy for recurrent or refractory primary CNS lymphoma
Abstract: BACKGROUND: High-dose methotrexate (MTX) and whole brain radiation therapy (WBRT) prolong survival in primary CNS lymphoma (PCNSL) patients but have been associated with delayed neurotoxicity. Consequently, patients are often treated with chemotherapy alone, and WBRT is deferred until relapse. METHODS: We performed a retrospective study to evaluate the safety and efficacy of salvage WBRT. Radiographic response, survival, and late neurotoxicity were assessed as the main endpoints. RESULTS: Forty-eight patients received salvage WBRT for PCNSL progression or recurrence. After WBRT, 58% achieved a complete radiographic response, 21% achieved a partial response, 6% had stable disease, and 15% progressed. The median survival from initiation of WBRT was 16 months, and 54% were alive 1 year after WBRT. The median time to PCNSL progression was 10 months; 15 patients (31%) had no subsequent disease recurrence after WBRT. Age younger than 60 years and complete response to WBRT were associated with better outcome. Treatment-related neurotoxicity was observed in 22% of patients. Patients older than 60 years and those treated less than 6 months from MTX therapy were at increased risk for development of neurotoxicity. CONCLUSIONS: Salvage whole brain radiation therapy (WBRT) is effective for recurrent and refractory primary CNS lymphoma. Reserving WBRT until tumor recurrence is a reasonable strategy to minimize or delay the risk of treatment-related neurotoxicity. ©2007AAN Enterprises, Inc.
Keywords: adult; cancer survival; clinical article; treatment outcome; aged; middle aged; survival rate; retrospective studies; salvage therapy; doxorubicin; cancer growth; antineoplastic agents; cancer radiotherapy; cytarabine; methotrexate; rituximab; temozolomide; topotecan; drug megadose; neurotoxicity; recurrent cancer; brain neoplasms; neoplasm recurrence, local; etoposide; radiotherapy; risk factors; combination chemotherapy; cyclophosphamide; vincristine; age factors; retrospective study; ifosfamide; procarbazine; thiotepa; risk assessment; radiation dosage; prednisolone; brain; lymphoma; cancer relapse; nerve degeneration; brain lymphoma
Journal Title: Neurology
Volume: 69
Issue: 11
ISSN: 0028-3878
Publisher: Lippincott Williams & Wilkins  
Date Published: 2007-09-11
Start Page: 1178
End Page: 1182
Language: English
DOI: 10.1212/01.wnl.0000276986.19602.c1
PUBMED: 17846417
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-34948849677&partnerID=40&md5=05be6f45ea07a1550f18a852c68671aa
Notes: --- - "Cited By (since 1996): 25" - "Export Date: 17 November 2011" - "CODEN: NEURA" - "Source: Scopus"
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MSK Authors
  1. Joachim Yahalom
    625 Yahalom
  2. Lisa De Angelis
    576 De Angelis
  3. Andreas Felix Hottinger
    14 Hottinger
  4. Lauren E Abrey
    278 Abrey
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