Primary CNS lymphoma treated with combined intra-arterial ACNU and radiotherapy.
OBJECTIVE
To assess whether nimustine (ACNU), a drug that can cross the blood brain barrier, combined with radiotherapy, improved the survival of patients with primary central nervous system lymphoma (PCNSL).


METHODS
Between 1995 and 2005, we treated 63 immunocompetent PCNSL patients with combination therapy consisting of intra-arterial ACNU (100 mg/m(2)) and whole brain radiotherapy (36-50 Gy). Their median age was 60 years (range 28-81). The median follow-up was 24 months.


RESULTS
With this regimen we achieved a complete response rate of 75% (43 of 57 patients). Kaplan-Meier estimates for median progression-free survival and median overall survival were 26 and 39 months, respectively. The 3- and 5-year survival rates were 51% (95% confidence interval [CI], 36-65%) and 32% (95% CI, 17-47%), respectively. By multivariate analysis, age (<60 vs. > or =60 years) was the only statistically significant prognostic factor; the WBRT dose, sex, and number of tumors were not significant prognostic factors in this study. Myelosuppression was the most frequent side effect, 60% of patients experienced grade 3-4 leukopenia. Late neurotoxicity as a result of treatment was observed in 14 of 43 patients (34%) and higher age (>60) was associated with a high risk of neurotoxicity.


CONCLUSIONS
The intra-arterial administration of ACNU combined with radiation therapy yielded a high response rate at acceptable toxicity levels in younger patients with PCNSL. However, late neurotoxicity was a serious complication in patients above 60 years of age.
Sonoda
Y
Y
Department of Neurosurgery, Miyagi Cancer Center Hospital, Natori, Japan. sono@nsg.med.tohoku.ac.jp
Matsumoto
K
K
Kakuto
Y
Y
Nishino
Y
Y
Kumabe
T
T
Tominaga
T
T
Katakura
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016399:Lymphoma, T-Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015376:Nimustine / Q000008:administration & dosage* / Q000009:adverse effects; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D015376:Nimustine