Combined-modality therapy for primary central nervous system lymphoma: long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group).
OBJECTIVE
To assess, in a multicenter setting, the long-term outcomes of a brief course of high-dose methotrexate followed by radiotherapy for patients with primary central nervous system lymphoma (PCNSL).


METHODS
Forty-six patients were entered in a Phase II protocol consisting of methotrexate (1 g/m(2) on Days 1 and 8), followed by whole-brain irradiation (45-50.4 Gy). The median follow-up time was 7 years, with a minimum follow-up of 5 years.


RESULTS
The 5-year survival estimate was 37% (+/-14%, 95% confidence interval [CI]), with progression-free survival being 36% (+/-15%, 95% CI), and median survival 36 months. Of the original 46 patients, 10 were alive, all without evidence of disease recurrence. A total of 11 patients have developed neurotoxicity, with the actuarial risk being 30% (+/-18%, 95% CI) at 5 years but continuing to increase. For patients aged>60 years the risk of neurotoxicity at 7 years was 58% (+/-30%, 95% CI).


CONCLUSIONS
Combined-modality therapy, based on high-dose methotrexate, results in improved survival outcomes in PCNSL. The risk of neurotoxicity for patients aged>60 years is unacceptable with this regimen, although survival outcomes for patients aged>60 years were higher than in many other series.
O'Brien
Peter C
PC
Radiation Oncology Department, Newcastle Mater Hospital, New South Wales, Australia. Peter.OBrien@mater.health.nsw.gov.au
Roos
Daniel E
DE
Pratt
Gary
G
Liew
K-H
KH
Barton
Michael B
MB
Poulsen
Michael G
MG
Olver
Ian N
IN
Trotter
Grant E
GE
D000328:Adult; D000367:Age Factors; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001259:Ataxia / Q000209:etiology / Q000401:mortality; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate