Improved survival rate in primary intracranial lymphoma treated by high-dose radiation and systemic vincristine-doxorubicin-cyclophosphamide-prednisolone chemotherapy

Abstract

Thirty patients with histologically proven primary intracranial non‐Hodgkin's lymphoma were treated at Kyoto University. Ten of them were treated prospectively with a radiation‐chemotherapy protocol. All but four specimens were recently reexamined and classified according to the Working Formulation system. The predominant histologic types were diffuse large cell type, large cell immunoblastic type, and diffuse mixed small and large cell type, seen in 38%, 21%, and 21% of cases, respectively. Before 1980, 16 patients were treated with postoperative radiation without definite chemotherapy, and only one has survived more than 5 years. Local recurrence was the most common cause of failure. In 1981, the authors started a protocol in which four to six courses of systemic chemotherapy with vincristine, doxorubicin, cyclophosphamide, and prednisolone (VEPA) was given after whole brain radiation (30–40 Gy) with a local boost up to 50 to 60 Gy. Eight patients completed this protocol, and all of them are alive at 16 to 100 months after diagnosis, with three patients surviving more than 5 years. Only one patient developed recurrence. On the other hand, six patients who did not complete or receive chemotherapy after 1981 are dead or alive with recurrence. Correlation between the Working Formulation subtype and prognosis was not clear because of the variety of treatment. Two patients receiving chemotherapy developed brain necrosis, which was fatal in one case, and the other two patients treated with the protocol are in a poor state without signs of recurrence. Chemotherapy may enhance the radiation effect on normal brain tissue as well as tumor. Combination of radiotherapy and chemotherapy can improve the survival rate, but the optimal dosage needs to be investigated further.

Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring

“…It could be valuable to study radiotherapy protocols giving a high dose (> 50 Gy) to the tumour bed and a reduced dose to the whole brain in risk groups 2 and 3. The association of chemotherapy and radiotherapy after surgery has been reported to yield better results than radiotherapy alone (Pollack et al, 1989;Michalski et al, 1990;Shibamato et al, 1989) although this has not consistently been found (Murray et al, 1986). An important point is whether a reduction of chemotherapy intensity in patients over 60 years may be responsible for the worse survival in this subgroup.…”

“…Among therapeutic features, the dose of radiation (Murray et al, 1986;Berry & Simpson, 1981;Pollack et al, 1989;Brada et al, 1990) and treatment with chemotherapy (Pollack et al, 1989;Michalski et al, 1990;Shibamato et al, 1989) The three remaining patients were treated with radiotherapy only because of patient refusal. Relapses were evidenced by CT scan in 20 patients.…”

Second-line treatment for primary central nervous system lymphoma

“…Complete data of disease-free survival (DFS), overall survival (OS) and management of recurrent or progressive disease after first-line treatment were available for each patient in 24 out of 59 considered series (Sagerman et al, 1967;Rampen et al, 1980;Letendre et al, 1982;Gonzalez and Schuster-Uitterhoeve, 1983;Mendenhall et al, 1983;Loeffler et al, 1985;Woodman et al, 1985;Di Marco et al, 1986;Murray et al, 1986;Vakili et al, 1986;Yasunaga et al, 1986;McLaughlin et al, 1988;Shibamoto et al, 1990;Uematsu et al, 1992;Watne et al, 1992;Boiardi et al, 1993;Glass et al, 1994Glass et al, , 1996Lachance et al, 1994;Ling et al, 1994;Selch et al, 1994;Ferreri et al, 1995b;Sarazin et al, 1995;Freilich et al, 1996). Three hundred and fiftyfive cases were reported in the analysed series: 334 patients received RT, CHT or CTM as first-line treatment, whereas 21 patients were not submitted to any therapy after diagnosis.…”

Primary central nervous system lymphoma: a role for adjuvant chemotherapy

“…A number of chemotherapeutic regimens have been evaluated in the treatment of immunocompetent patients with primary CNS lymphoma both in the adjuvant and recurrent setting [1,[3][4][5][6][12][13][14][15][16][17]. Given the large number of drugs active against extraneural non-Hodgkins lymphoma, it is not surprising to find a variety of drugs employed against primary CNS lymphoma.…”