Patterns of treatment in older adults with primary central nervous system lymphoma Journal Article

Authors: Panageas, K. S.; Elkin, E. B.; Ben-Porat, L.; Deangelis, L. M.; Abrey, L. E.
Article Title: Patterns of treatment in older adults with primary central nervous system lymphoma
Abstract: BACKGROUND. The incidence of primary central nervous system lymphoma (PCNSL) has increased in recent decades and is highest in people aged ≥65 years. Radiotherapy (XRT) and systemic chemotherapy (CTX), alone or in combination, are reported to extend survival, but treatment-related toxicity is a particular concern in the elderly. The objective of the current study was to identify factors associated with the receipt and type of treatment in a population-based cohort of older PCNSL patients. METHODS. Using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, the authors identified PCNSL cases in adults aged ≥65 years who were diagnosed between 1994 and 2002. Initial treatment was defined as XRT alone, CTX alone, combined CTX and XRT, or no treatment, based on Medicare claims in the 6 months after diagnosis. The authors assessed the effects of age, comorbidity, and sociodemographic characteristics on the odds of receiving treatment. RESULTS. Of 579 PCNSL patients, 464 (80%) received any treatment. XRT alone was the most common modality (46%), followed by combined therapy (33%) and CTX alone (22%). The type of treatment varied by age (P < .0001). The use of CTX alone or in combination with XRT decreased with increasing age, whereas the use of XRT alone increased with age. In adjusted analysis, younger age (P < .01) was found to be predictive of the receipt of any treatment. The use of CTX decreased with age (P < .0001). The median survival was 7 months (95% confidence interval, 6-8 months); no significant time trends were observed. CONCLUSIONS. Although the majority of older PCNSL patients received treatment, most did not receive optimal therapy. Age was found to have the greatest influence on treatment selection. Overall survival in elderly PCNSL patients appears to be poor. © 2007 American Cancer Society.
Keywords: cancer survival; controlled study; aged; aged, 80 and over; survival analysis; retrospective studies; major clinical study; cancer combination chemotherapy; united states; cancer radiotherapy; chemotherapy, adjuvant; radiotherapy, adjuvant; chemotherapy; primary central nervous system lymphoma; treatment; antineoplastic agent; disease association; cohort studies; radiotherapy; cohort analysis; odds ratio; central nervous system neoplasms; medicare; registries; lymphoma; seer program; elderly; immunocompetence
Journal Title: Cancer
Volume: 110
Issue: 6
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2007-09-15
Start Page: 1338
End Page: 1344
Language: English
DOI: 10.1002/cncr.22907
PUBMED: 17647247
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 12" - "Export Date: 17 November 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Elena B Elkin
    149 Elkin
  2. Lauren E Abrey
    271 Abrey
  3. Katherine S Panageas
    325 Panageas