Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function
| Autor: | Bruce Dana, Suellen A. Dahlborg, Edward A. Neuwelt, John R. Crossen, Simon Roman-Goldstein, Fred L. Ramsey, David L. Goldman, Rita M. Braziel |
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| Rok vydání: | 1991 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Lymphoma medicine.medical_treatment Leucovorin Neuropsychological Tests Dexamethasone Cognition Antineoplastic Combined Chemotherapy Protocols medicine Humans Cyclophosphamide Survival rate Survival analysis Proportional Hazards Models Chemotherapy Brain Neoplasms business.industry Proportional hazards model Combination chemotherapy Middle Aged Prognosis medicine.disease Surgery Survival Rate Radiation therapy Methotrexate Oncology Blood-Brain Barrier Tumor progression Procarbazine Female business |
| Zdroj: | Journal of Clinical Oncology. 9:1580-1590 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.1991.9.9.1580 |
| Popis: | Combination chemotherapy with or without radiotherapy has had only modest efficacy in the treatment of primary CNS lymphoma. Median survival of these patients, treated primarily with radiotherapy, is 13 months; 5-year survival is less than 5%. Thirty consecutive non-acquired immune deficiency syndrome patients with primary CNS lymphoma were treated with barrier-dependent chemotherapy using intraarterial mannitol to open the blood-brain barrier (BBB). Follow-up included extensive neuropsychologic testing of all patients. Thirteen patients received cranial radiation 1 to 9 months before referral (group 1). Seventeen patients received initial BBB disruption chemotherapy with subsequent radiation only for tumor progression or recurrence (group 2). The difference in median survivals from diagnosis--17.8 months for group 1 and 44.5 months for group 2--was statistically significant (P = .039). Group 1 survival is comparable with the 20-month median survival of a historical series of patients (n = 208) treated with radiotherapy with or without chemotherapy. Group 2 patient survival represents an advance in the survival of CNS lymphoma and was associated with preservation of cognitive function in six of seven nonirradiated complete responders observed for 1 to 7 years. Patient toxicity was manageable in this intensive therapeutic regimen. In this series, a plateau in survival curves suggests that a major portion of these patients may be cured without the neuropsychologic sequelae associated with cranial radiation. |
| Databáze: | OpenAIRE |
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