Long-term survival following radiotherapy and cytarabine chemotherapy for sporadic primary central nervous system lymphoma.
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.
Pöttgen
Christoph
C
Department of Radiotherapy, University Hospital Essen, Germany. christoph.poettgen@uni-essen.de
Stuschke
Martin
M
Stüben
Georg
G
Schmitz
Armin
A
Schwechheimer
Karl
K
Wacker
Hans-Heinrich
HH
Rauhut
Friedhelm
F
Kleuker
Susanne
S
Wilhelm
Hans
H
Grehl
Sara
S
Fehlings
Thorsten
T
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
D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine