Characteristics and outcomes of elderly patients with primary central nervous system lymphoma: The Memorial Sloan-Kettering Cancer Center experience Journal Article

Authors: Ney, D. E.; Reiner, A. S.; Panageas, K. S.; Brown, H. S.; Deangelis, L. M.; Abrey, L. E.
Article Title: Characteristics and outcomes of elderly patients with primary central nervous system lymphoma: The Memorial Sloan-Kettering Cancer Center experience
Abstract: BACKGROUND: Approximately 50% of all patients with primary central nervous system lymphoma (PCNSL) are aged ≥65 years; however, this group is relatively understudied, and to the authors's knowledge, optimal treatment for older patients is not well defined. METHODS: This was a retrospective review of PCNSL patients aged ≥65 years who were treated at Memorial Sloan-Kettering Cancer Center between 1986 and 2008. A multivariate analysis of demographic and clinical variables on prognosis and receipt of treatment was performed. RESULTS: One hundred seventy-four patients between the ages of 65 and 89 years were identified; there was a slight predominance of women (52.9%). One hundred forty-eight patients were treated with chemotherapy at the time of diagnosis (98% with methotrexatebased therapy) and 31 of these patients also received whole-brain radiotherapy (WBRT). Sixteen patients received WBRT alone. A radiographic response to chemotherapy was noted in 76% of patients. Ninety patients developed disease progression after initial treatment; 74 received salvage therapy and 48% of these patients responded to salvage treatment. The median overall survival was 25 months (range, 18-33 months), and the 3-year survival rate was 36%. Approximately 20.1% of patients were alive for ≥11 years. WBRT was delivered more frequently before 1998, and patients with a history of prior malignancy were less likely to receive WBRT. Age and performance status were identified as the most important predictors of survival. Treatment-related neurotoxicity at 2 years was strongly associated with receipt of WBRT (P = .0002). CONCLUSIONS: PCNSL in the elderly remains sensitive to methotrexate-based chemotherapy and aggressive treatment may be warranted both at the time of diagnosis and disease recurrence. © 2010 American Cancer Society.
Keywords: adult; treatment outcome; treatment response; aged; aged, 80 and over; disease-free survival; survival rate; major clinical study; overall survival; salvage therapy; cancer growth; combined modality therapy; chemotherapy; primary central nervous system lymphoma; methotrexate; brain radiation; drug megadose; neurotoxicity; brain neoplasms; nephrotoxicity; radiation; antineoplastic combined chemotherapy protocols; age factors; retrospective study; central nervous system neoplasms; lymphoma, non-hodgkin; elderly
Journal Title: Cancer
Volume: 116
Issue: 19
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2010-10-01
Start Page: 4605
End Page: 4612
Language: English
DOI: 10.1002/cncr.25363
PUBMED: 20572045
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Anne S Reiner
    120 Reiner
  2. Douglas Edward Ney
    8 Ney
  3. Hayley Skinner Brown
    2 Brown
  4. Lauren E Abrey
    272 Abrey
  5. Katherine S Panageas
    327 Panageas