A Retrospective Analysis of R-MPV Plus Response-adapted Whole-brain Radiotherapy for Elderly Patients with Primary Central Nervous System Lymphoma
| Autor: | Shunichi Ishihara, Naoto Imoto, Rie Ito, Shinji Fujiwara, Shingo Kurahashi, Yutaro Suzuki, Toshiyasu Sakai, Satomi Yamamoto, Isamu Sugiura |
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| Rok vydání: | 2022 |
| Předmět: |
Central Nervous System
Vincristine medicine.medical_specialty Lymphoma medicine.medical_treatment Procarbazine Central Nervous System Neoplasms Internal medicine Antineoplastic Combined Chemotherapy Protocols Internal Medicine medicine Humans Cumulative incidence Aged Retrospective Studies Performance status business.industry Primary central nervous system lymphoma Brain General Medicine Middle Aged medicine.disease Combined Modality Therapy Radiation therapy Regimen Methotrexate Treatment Outcome Rituximab Neoplasm Recurrence Local business medicine.drug |
| Zdroj: | Internal Medicine. 61:1345-1352 |
| ISSN: | 1349-7235 0918-2918 |
| DOI: | 10.2169/internalmedicine.7805-21 |
| Popis: | Objective Few reports have described the real-world outcomes of rituximab, methotrexate (MTX), procarbazine, and vincristine (R-MPV) plus response-adapted whole-brain radiotherapy (WBRT) for elderly patients with primary central nervous system lymphoma (PCNSL). We evaluated the outcome of this regimen. Methods We evaluated >60-year-old patients with newly diagnosed PCNSL who received R-MPV plus WBRT from January 2010 to December 2019 at Toyohashi Municipal Hospital. The patients' characteristics, regimen enforcement, response rate, survival, and toxicity were analyzed. Patients Ten patients were consecutively enrolled. Their median age was 69 years old, and 60% had a performance status of 3 or 4 before induction therapy. Results Seven patients achieved a complete response after induction, and all 10 patients achieved a complete response after consolidation. Seven received reduced-dose WBRT at 23.4 Gy, and 2 received WBRT at 45 Gy. The median follow-up was 44.4 months; the 3-year progression-free survival and overall survival rates were 60% and 80%, respectively; and the cumulative incidence of relapse was 40%. The incidence of symptomatic delayed neurotoxicity was 70%. Of the 7 patients who received reduced-dose WBRT, 4 (57%) developed delayed neurotoxicity, including 1 severely affected patient. Only one patient survived without relapse and delayed neurotoxicity. The ratio of patients who developed relapse or delayed neurotoxicity that impaired daily life was 33% and 100% in the MTX high- and low-intensity groups, respectively. Conclusion This regimen in elderly patients is unsatisfactory because of delayed neurotoxicity. We should consider maintaining an adequate MTX intensity, postponing or minimizing WBRT, and choosing high-dose consolidation therapy for select patients. |
| Databáze: | OpenAIRE |
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