A multicenter study of treatment of primary CNS lymphoma.
OBJECTIVE
To characterize the therapeutic variables correlated to outcome in 370 patients with primary CNS lymphoma.


METHODS
Planned treatment was radiotherapy (RT) in 98 patients, chemotherapy (CHT) in 32, RT followed by CHT in 36, and CHT followed by RT in 197 patients. High-dose methotrexate (HD-MTX; 1 to 8 g/m2) was used in 169 patients and intrathecal CHT in 109.


RESULTS
One hundred sixteen patients are alive (median follow-up 24 months), with a 2-year overall survival of 37%. Patients treated with CHT followed by RT had improved survival with respect to patients treated with RT alone. Patients receiving HD-MTX-based primary CHT survived longer than those treated with other drugs. HD-MTX associated with other cytostatics, in particular HD-cytarabine, produced better results than HD-MTX alone. No correlation between MTX dose and survival was found. In patients receiving HD-MTX, consolidation RT or intrathecal CHT did not improve survival. Age, performance status, lactate dehydrogenase serum level, CSF protein level, site of disease, and use of HD-MTX were all predictors of survival.


CONCLUSIONS
Combination CHT-RT is superior to RT alone. Patients treated with primary CHT containing HD-MTX exhibited improved survival. In these patients, the addition of HD-cytarabine was associated with a better survival, whereas intrathecal CHT was not correlated to outcome. RT may be unnecessary in patients achieving complete remission after receiving HD-MTX-based primary CHT.
Ferreri
A J M
AJ
Department of Radiochemotherapy, San Raffaele H. Scientific Institute, Milan, Italy. andres.ferreri@hsr.it
Reni
M
M
Pasini
F
F
Calderoni
A
A
Tirelli
U
U
Pivnik
A
A
Aondio
G M
GM
Ferrarese
F
F
Gomez
H
H
Ponzoni
M
M
Borisch
B
B
Berger
F
F
Chassagne
C
C
Iuzzolino
P
P
Carbone
A
A
Weis
J
J
Pedrinis
E
E
Motta
T
T
Jouvet
A
A
Barbui
T
T
Cavalli
F
F
Blay
J Y
JY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis