Treatment of primary central nervous system lymphoma in the elderly.
Although the incidence of primary central nervous system lymphoma has recently declined among people with acquired immunodeficiency syndrome, the incidence of primary central nervous system lymphoma remains high among the immunocompetent population >/=60 years of age. Elderly patients represent an important subgroup that accounts for approximately half of primary central nervous system lymphoma cases. Radiotherapy (RT) alone has produced disappointing results in the elderly. Improved clinical outcomes have been achieved with high-dose methotrexate-based chemotherapy regimens in combination with whole-brain RT. Unfortunately, combination therapy exposes elderly patients to a high risk of severe delayed neurotoxicity in up to 80%. Chemotherapy alone may be the best approach for treating elderly patients and appears to be more effective than RT, while considerably reducing the risk of neurotoxicity. Clinical studies are needed to define the optimal chemotherapy regimen for the elderly in an effort to delay or completely avoid the need for RT.
Hoang-Xuan
Khê
K
Fédération Neurologique Mazarin (Pr JY Delattre), Groupe Hospitalier Pitié-Salpêtrire, 47 Boulevard de l'Hopital, Paris 75013, France.
Chinot
Olivier L
OL
Taillandier
Luc
L
D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D003131:Combined Modality Therapy; D003704:Dementia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate
D008727:Methotrexate