Long-term survival following radiotherapy and cytarabine chemotherapy for sporadic primary central nervous system lymphoma

Autor: Thorsten Fehlings, Hans Wilhelm, Martin Stuschke, Susanne Kleuker, Hans-Heinrich Wacker, Christoph Pöttgen, Sara Grehl, Friedhelm Rauhut, Georg Stüben, Karl Schwechheimer, Armin Schmitz
Jazyk: angličtina
Rok vydání: 2003
Předmět:
Adult
Male
medicine.medical_specialty
Antimetabolites
Antineoplastic
Lymphoma
B-Cell
Time Factors
Lymphoma
medicine.drug_class
medicine.medical_treatment
Medizin
Lymphoma
T-Cell
Antimetabolite
Cause of Death
Confidence Intervals
Medicine
Humans
Radiology
Nuclear Medicine and imaging
ddc:610
Injections
Spinal
Aged
Chemotherapy
business.industry
Brain Neoplasms
Lymphoblastic lymphoma
Primary central nervous system lymphoma
Cytarabine
Induction chemotherapy
Radiotherapy Dosage
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
medicine.disease
Combined Modality Therapy
Survival Analysis
Surgery
Radiation therapy
Oncology
Injections
Intravenous
Lymphoma
Large-Cell
Anaplastic
Female
Dose Fractionation
Radiation
Lymphoma
Large B-Cell
Diffuse
business
Progressive disease
medicine.drug
Follow-Up Studies
Popis: To analyze the long-term results following whole brain radiotherapy (WBRT) with sequential intrathecal (i.th.) cytosine arabinoside (Ara-C) ± intravenous (i.v.) Ara-C in patients with primary central nervous system lymphoma (PCNSL). 14 patients were treated between July 1987 and August 1995. All had sporadic PCNSL with proven histology of high-grade CNS lymphoma (twelve diffuse large-cell B-lymphomas, one lymphoblastic lymphoma, one large T-cell lymphoma). Patients were treated with two to four cycles of induction chemotherapy (40 mg/m2 Ara-C i.th.), four patients received additional Ara-C i.v. (150 mg/m2, d1–4). WBRT was administered using 1.8-Gy fractions. Intrathecal chemotherapy was planned afterwards in 4-week intervals for 6 months. Posttreatment neurocognitive evaluations were performed in two long-term survivors. Two of four patients who received i.v. and i.th. induction chemotherapy showed progressive disease, and irradiation was started immediately. Six of 14 patients received 50.4 Gy WBRT, four patients had WBRT up to 39.6 Gy followed by a 10.8-Gy boost. Five patients died early during therapy either due to a decline of the general medical condition or progressive disease. Median survival was 41 months (95% confidence interval: 6–79 months), survival at 3 and 5 years was 59% and 42%, respectively. Six patients survived for 3 years, two younger patients are still alive (> 12 years). They show only slightly impaired neurocognitive functions without clinical relevance. This WBRT-based protocol with i.th. meningeal prophylaxis using Ara-C ± i.v. Ara-C yields substantial long-term survival with moderate toxicity. The value of i.v. chemotherapy is currently being investigated in prospective studies.
Databáze: OpenAIRE
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