title: Long-term survival following radiotherapy and cytarabine chemotherapy for sporadic primary central nervous system lymphoma.
abstract: OBJECTIVE
  To analyze the long-term results following whole brain radiotherapy (WBRT) with sequential intrathecal (i.th.) cytosine arabinoside (Ara-C) +/- intravenous (i.v.) Ara-C in patients with primary central nervous system lymphoma (PCNSL).
  
  
  METHODS
  14 patients were treated between July 1987 and August 1995. All had sporadic PCNSL with proven histology of high-grade CNS lymphoma (twelve diffuse large-cell B-lymphomas, one lymphoblastic lymphoma, one large T-cell lymphoma). Patients were treated with two to four cycles of induction chemotherapy (40 mg/m2 Ara-C i.th.), four patients received additional Ara-C i.v. (150 mg/m2, d1-4). WBRT was administered using 1.8-Gy fractions. Intrathecal chemotherapy was planned afterwards in 4-week intervals for 6 months. Posttreatment neurocognitive evaluations were performed in two long-term survivors.
  
  
  RESULTS
  Two of four patients who received i.v. and i.th. induction chemotherapy showed progressive disease, and irradiation was started immediately. Six of 14 patients received 50.4 Gy WBRT, four patients had WBRT up to 39.6 Gy followed by a 10.8-Gy boost. Five patients died early during therapy either due to a decline of the general medical condition or progressive disease. Median survival was 41 months (95% confidence interval: 6-79 months), survival at 3 and 5 years was 59% and 42%, respectively. Six patients survived for 3 years, two younger patients are still alive (> 12 years). They show only slightly impaired neurocognitive functions without clinical relevance.
  
  
  CONCLUSIONS
  This WBRT-based protocol with i.th. meningeal prophylaxis using Ara-C +/- i.v. Ara-C yields substantial long-term survival with moderate toxicity. The value of i.v. chemotherapy is currently being investigated in prospective studies.
authors: Department of Radiotherapy, University Hospital Essen, Germany. christoph.poettgen@uni-essen.de
authors: Christoph
authors: C
authors: Pöttgen
authors: Martin
authors: M
authors: Stuschke
authors: Georg
authors: G
authors: Stüben
authors: Armin
authors: A
authors: Schmitz
authors: Karl
authors: K
authors: Schwechheimer
authors: Hans-Heinrich
authors: HH
authors: Wacker
authors: Friedhelm
authors: F
authors: Rauhut
authors: Susanne
authors: S
authors: Kleuker
authors: Hans
authors: H
authors: Wilhelm
authors: Sara
authors: S
authors: Grehl
authors: Thorsten
authors: T
authors: Fehlings
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy*; D002423:Cause of Death; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003561:Cytarabine / Q000008:administration & dosage / Q000627:therapeutic use*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007278:Injections, Spinal; D008223:Lymphoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy*; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D017728:Lymphoma, Large-Cell, Anaplastic / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D016399:Lymphoma, T-Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine