The treatment of primary central nervous system lymphoma in 122 immunocompetent patients: a population-based study of successively treated cohorts from the British Colombia Cancer Agency
| Autor: | Joseph M. Connors, E M B Susan O'Reilly, Richard Klasa, Laurie Sehn, James Morris, Mukesh Chhanabhai, Tamara N. Shenkier, M B Nicholas Voss, Randall Fairey, Randy D. Gascoyne, Tom Pickles, Paul Hoskins |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Vincristine Cyclophosphamide Lymphoma medicine.medical_treatment Population CHOP Disease-Free Survival Central Nervous System Neoplasms Cohort Studies Internal medicine Antineoplastic Combined Chemotherapy Protocols Medicine Humans education Aged Chemotherapy education.field_of_study business.industry Hazard ratio Primary central nervous system lymphoma Middle Aged medicine.disease Combined Modality Therapy Surgery Survival Rate Methotrexate Oncology Doxorubicin Prednisone Female Cranial Irradiation business Progressive disease medicine.drug |
| Zdroj: | Cancer. 103(5) |
| ISSN: | 0008-543X |
| Popis: | BACKGROUND The objective of this study was to evaluate the clinical outcome of a population-based cohort of immunocompetent patients with primary central nervous system lymphoma (PCNSL) treated with 3 different strategies over 13 years. METHODS One hundred twenty-two consecutive patients (median age, 66 years) with PCNSL were identified. Three treatment strategies were employed: 1) whole-brain irradiation with (from January, 1990, to June, 1991) or without (from April, 1995, to December, 1999) cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-type chemotherapy (n = 50 patients); 2) combined-modality therapy, including 1 g/m2 methotrexate plus whole-brain irradiation (from July, 1991, to March, 1995; n = 34 patients); and 3) 8 g/m2 methotrexate alone (from January, 2000, to March, 2003) with whole-brain irradiation reserved for those with progressive disease (n = 38 patients). Treatment failure was defined as progressive disease, disease recurrence, death from toxicity or lymphoma, or toxicity that necessitated a change in primary treatment. RESULTS The median failure-free survival was 7 months, and the median overall survival (OS) was 17 months. The median OS was similar in all 3 eras. In this population-based analysis, one-third of patients did not receive the treatment strategy of the era. Therefore, the data also were analyzed by treatment received. On multivariate analysis (including era of treatment), 3 factors—age > 60 years, lactate dehydrogenase > normal, and omission of methotrexate—were associated significantly with poorer OS (hazard ratio: 2.3, 2.2, and 2.3, respectively). CONCLUSIONS Outcomes for a general population with PCNSL remained constant despite different treatment strategies over three eras. For the two-thirds of patients who could receive potentially curative treatment, age, lactate dehydrogenase level, and receipt of ≥ 1 g/m2 methotrexate appeared to be important determinants of OS. Cancer 2005. © 2005 American Cancer Society. |
| Databáze: | OpenAIRE |
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