Results of Treatment of 112 Cases of Primary CNS Lymphoma
| Autor: | Ryuya Yamanaka, Tetsuro Tamura, Naoto Tsuchiya, Junpei Homma, Naoki Yajima, Hiroaki Hondoh, Masakazu Sano, Ryuichi Tanaka, Ken Morii, Yoshikatsu Shinbo, Hitoshi Takahashi, Tatsuyuki Kakuma |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Oncology Cancer Research Lymphoma medicine.medical_treatment Leucovorin Kaplan-Meier Estimate Procarbazine Central Nervous System Neoplasms Cognition Prednisone Antineoplastic Combined Chemotherapy Protocols Etoposide Aged 80 and over Primary central nervous system lymphoma General Medicine Middle Aged Chemotherapy regimen Treatment Outcome Chemotherapy Adjuvant Vincristine Female medicine.drug Adult medicine.medical_specialty Pirarubicin Disease-Free Survival Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Mechlorethamine Karnofsky Performance Status Cyclophosphamide Aged Neoplasm Staging Retrospective Studies Salvage Therapy Chemotherapy business.industry medicine.disease Surgery Methotrexate Doxorubicin Radiotherapy Adjuvant Cranial Irradiation business |
| Zdroj: | Japanese Journal of Clinical Oncology. 38:373-380 |
| ISSN: | 1465-3621 0368-2811 |
| Popis: | Background: Chemotherapy with or without radiotherapy is the mainstay of treatment for primary central nervous system lymphoma (PCNSL). High-dose methotrexate (MTX) is the most effective drug available to treat these lesions, either as a single agent or in combination with other drugs. Due to the lack of well-conducted randomized trials, the optimal treatment remains controversial. Available retrospective studies are difficult to discuss, however, some common themes can be found. Methods: One hundred and twelve patients with PCNSL were treated with four different regimens over a period of 24 years. Treatment regimens were: whole-brain irradiation (WBI) alone, MVP (MTX, vincristine, and predonisolone), ProMACE-MOPP hybrid (cyclophosphamide, pirarubicin, etoposide, vincristine, procarbazine, prednisone, and MTX) and R-MTX (rituximab, MTX, pirarubicin, procarbazine, and prednisone) combined-modality therapy. Results: The median failure-free survival was 16 months, and the median overall survival (OS) was 24 months. The 2- and 5-year actuarial probability of survival was 52.4+4.8% [95% confidence intervals (CI)] and 30.2+4.8% (95% CI), respectively. The ProMACEMOPP protocol, Karnofsky performance status (KPS), MTX dose and WBI were associated with good OS by univariate models. By multivariate analysis, MTX dose, WBI dose, and its square dose were significantly associated with good OS. 20‐30 Gy WB, and 500 mg/m 2 of MTX dose appeared important determinants of OS. Conclusions: A modest dose of MTX (500 mg/m 2 ) followed by reduced-dose WBI for patients who respond appears a feasible treatment approach that minimizes serious toxicity. |
| Databáze: | OpenAIRE |
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