A multicenter study of treatment of primary CNS lymphoma

Abstract

Combination CHT-RT is superior to RT alone. Patients treated with primary CHT containing HD-MTX exhibited improved survival. In these patients, the addition of HD-cytarabine was associated with a better survival, whereas intrathecal CHT was not correlated to outcome. RT may be unnecessary in patients achieving complete remission after receiving HD-MTX-based primary CHT.

Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study

“…Reasons to omit intraventricular therapy in the current trial were a high Ommaya reservoir infection rate and data from retrospective analysis putting into doubt the necessity of intraventricular treatment [4,5]. However, an interim analysis two years after initiation of this trial revealed an unexpectedly high relapse rate with a median response duration of only ten months in responding patients.…”

“…Two retrospective analyses addressing the efficacy of intrathecal chemotherapy in PCNSL [4,5] did not find the inclusion of this modality influencing survival. Precise dosage, application route and schedule of intrathecal therapy were not given in a retrospective analysis on 109 out of 363 PCNSL patients treated with heterogeneous regimens including chemotherapy alone, radiotherapy (RT) alone, RT followed by chemotherapy and vice versa [4].…”

“…Precise dosage, application route and schedule of intrathecal therapy were not given in a retrospective analysis on 109 out of 363 PCNSL patients treated with heterogeneous regimens including chemotherapy alone, radiotherapy (RT) alone, RT followed by chemotherapy and vice versa [4]. However, only 11 out of the 109 patients treated with intrathecal chemotherapy had not been treated with RT in this series [4]. Given the fact that RT is an efficient modality to control lymphomatous meningial tumor manifestation, a possible prophylactic or therapeutic effect of intrathecal chemotherapy might have been obscured by whole brain RT.…”

“…However, Ommaya reservoir infection occurred in 19% of the whole group, and represented a serious complication in some patients, resulting in interruption or delay of chemotherapy. [3] Therefore, and considering data from the literature questioning the benefit of intraventricular chemotherapy in PCNSL [4,5], we treated patients with systemic therapy only in a subsequent phase II trial initiated in 08/2003.…”

Area under the curve of methotrexate and creatinine clearance are outcome-determining factors in primary CNS lymphomas

“…(Reni et al, 1997;Ferreri et al, 2002b). Any chemotherapy regimen without HD-MTX is associated with outcomes no better than those obtained with radiotherapy (RT) alone in these malignancies (Schultz et al, 1996;O'Neill et al, 1999;Mead et al, 2000), while the survival benefit of the addition of other drugs to HD-MTX remains a matter of debate (Reni et al, 2001;Ferreri et al, 2002b). In spite of its central role in PCNSL treatment, the optimal dose, administration schedule, and dose timing of MTX have not been clearly defined.…”