title: Primary central nervous system lymphoma in the elderly: a multicentre retrospective analysis.
abstract: Elderly patients with primary central nervous ystem lymphoma (PCNSL) do not tolerate treatment with combined radio-chemotherapy well because of leuco-encephalopathy; they are usually treated initially with chemotherapy or radiotherapy alone. Little is known about the efficacy and toxicity of these treatments outside clinical studies. This study was a retrospective analysis of all patients aged 60 years or over who were admitted with PCNSL to one of five Dutch centers between 1998 and 2007. A total of 74 patients were identified. Twenty-nine were treated with radiotherapy only (Group A), in 36 the intended treatment was chemotherapy alone (Group B), and nine were planned to receive chemotherapy followed by radiotherapy (Group C). Median overall survival was 20 months; 4 months in patients with a Karnofsky performance status (KPS) <70, 25 months in patients with a KPS ≥ 70 (P < 0·001). Treatment modality was not an independent prognostic factor. Forty patients were treated with methotrexate 3 g/m(2) : there were two toxic deaths. Ten patients discontinued chemotherapy because of toxicity. Delayed encephalopathy was reported in 10 patients. In conclusion, community hospitals still frequently utilize whole brain radiotherapy in elderly PCNSL patients, though a majority tolerates chemotherapy well. Performance status was the most important variable determining prognosis. Short and long term toxicities must be weighed against possible clinical benefits of each treatment, making treatment decisions a highly individualized process.
authors.affiliation: Department of Neuro-Oncology, Daniël den Hoed Cancer Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Mascha
authors.initials: M
authors.lastname: Schuurmans
authors.forename: Jacoline E C
authors.initials: JE
authors.lastname: Bromberg
authors.forename: Jeanette
authors.initials: J
authors.lastname: Doorduijn
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
authors.forename: Tatjana
authors.initials: T
authors.lastname: Seute
authors.forename: Roelien
authors.initials: R
authors.lastname: Enting
authors.forename: Gustaaf
authors.initials: G
authors.lastname: van Imhoff
authors.forename: Yvette
authors.initials: Y
authors.lastname: van Norden
authors.forename: Martin J
authors.initials: MJ
authors.lastname: van den Bent
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000532:radiotherapy*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D008727:Methotrexate