Analysis of Radiotherapy in 1054 Patients with Primary Central Nervous System Lymphoma Treated from 1985 to 2009 |
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| Affiliation: | 1. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;2. Japanese Radiation Oncology Study Group, Tokyo, Japan;1. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;2. Japanese Radiation Oncology Study Group, Tokyo, Japan;1. Department of Radiological Science, University of Messina, Messina, Italy;2. Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy;3. Operative Unit of Radiation Oncology, Azienda Ospedaliera Papardo-Piemonte, Messina, Italy;1. Department of Haematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany;2. Clinical Trials Unit, University of Freiburg Medical Centre, Freiburg, Germany;3. Department of Medicine, Royal Marsden Hospital, London, UK;4. Department of Haematology and Oncology, Heidelberg University, Heidelberg, Germany;5. Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Kiel, Germany;6. III Medical Department, Technische Universität München, Munich, Germany;7. Department of Haematology and Oncology, University Hospital Halle, Halle, Germany;8. Hematology and Oncology, Clinic for Internal Medicine C, University of Greifswald, Greifswald, Germany;9. Department of Internal Medicine III, University of Ulm, Ulm, Germany;10. Department of Internal Medicine II, Oncology, Hematology, and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;11. Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany;12. Department of Medicine, University Hospital Regensburg, Regensburg, Germany;13. Department of Haematology and Oncology, HELIOS Dr Horst Schmidt Kliniken, Wiesbaden, Germany;14. Medizinische Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany;15. Department of Haematology and Oncology, University of Tübingen, Tübingen, Germany;p. Department of Haematology, Medical Faculty, University of Duisburg-Essen, Essen, Germany;q. Klinik für Innere Medizin I, Universität des Saarlandes, Homburg, Germany;r. Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany;s. Institute of Neuropathology, University Hospital of Cologne, Cologne, Germany;t. Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany;u. Department of Hematology, Oncology, and Stem-Cell Transplantation, University Medical Hospital and Faculty of Medicine, Albert-Ludwigs University, Freiburg, Germany;1. Hôpital René-Huguenin – Institut Curie, Service hématologie, 35, rue Dailly, 92210 Saint-Cloud, France;2. Groupe hospitalier Pitié-Salpêtrière, Service de neurologie, 47-83, boulevard de l’Hôpital, 75013 Paris, France;3. Groupe hospitalier Pitié-Salpêtrière, Service d’hématologie, 47-83, boulevard de l’Hôpital, 75013 Paris, France;4. Centre expert national des lymphomes primitifs du système nerveux central (LOC) - Réseau cancer rare de l’INCa;5. Centre expert des cancers viro-induits post-transplantation |
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| Abstract: | AimsData on primary central nervous system lymphoma that had been collected through surveys for four consecutive periods between 1985 and 2009 were analysed to evaluate outcomes according to treatment.Materials and methodsAll had histologically proven disease and had received radiotherapy. No patients had AIDS. Among 1054 patients, 696 died and 358 were alive or lost to follow-up. The median follow-up period for surviving patients was 37 months.ResultsFor all patients, the median survival time was 24 months; the 5 year survival rate was 25.8%. Patients treated with methotrexate-based chemotherapy and radiation had a higher 5 year survival rate (43%) than those treated with radiation alone (14%) and those treated with non-methotrexate chemotherapy plus radiation (20%), but differences in relapse-free survival were smaller among the three groups. The 5 year survival rate was 25% for patients treated with whole-brain irradiation and 29% for patients treated with partial-brain irradiation (P = 0.80). Patients receiving a total dose of 40–49.9 Gy had a higher 5 year survival rate (32%) than those receiving other doses (21–25%, P = 0.0004) and patients receiving a whole-brain dose of 30–39.9 Gy had a higher 5 year survival rate (32%) than those receiving ≥40 Gy (13–22%, P < 0.0005). Patients receiving methotrexate-based chemotherapy and partial-brain radiotherapy (≥30 Gy) had a 5 year survival rate of 49%.ConclusionsThe optimal total and whole-brain doses may be in the range of 40–49.9 and <40 Gy, respectively, especially in combination with chemotherapy. Patients receiving partial-brain irradiation had a prognosis similar to that of those receiving whole-brain irradiation. With methotrexate-based chemotherapy, partial-brain radiotherapy may be worth considering for non-elderly patients with a single tumour. |
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| Keywords: | Brain neoplasm central nervous system chemotherapy lymphoma neurocognitive function radiotherapy |
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