Non-Hodgkin's lymphoma of the brain: Can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation therapy Oncology Group (RTOG): RTOG 8315

Nelson, Diana F.; Martz, Karen; Bonner, Hugh; Nelson, James S.; Newall, Joseph; Kerman, Herbert D.; Thomson, John W.; Murray, Kevin

doi:10.1016/0360-3016(92)90538-s

Cited by 576 publications

(286 citation statements)

References 25 publications

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“…Four retreated patients were still alive 6Ð48 months after recurrence. In contrast, a few authors reported poor results with salvage therapy (Soci• et al, 1990;Nelson et al, 1992;Krogh-Jensen et al, 1994). However, the number of patients was small and data not complete.…”

Section: Discussionmentioning

confidence: 99%

Second-line treatment for primary central nervous system lymphoma

1999

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Summary Failure after first-line treatment was reported in 35-60% of immunocompetent patients with primary central nervous system lymphoma (PCNSL). There are currently no reports focusing on salvage therapy. This review analyses prognostic factors and the efficacy of salvage therapy by focusing on data from papers reporting results of first-line treatment in 355 cases. The study group consisted of 173 patients presenting treatment failure. The interval between failure and death (TTD) was compared for age at relapse (≤60 vs >60 years), type of failure (relapse vs progression), time to relapse (≤12 vs >12 months) and salvage treatment (yes vs no). Median TTD was similar in younger and older patients (P = 0.09). Relapsed patients had a longer TTD than patients with progressive disease (P = 0.002). Early relapse led to a shorter TTD than late relapse (P = 0.005). Median TTD was 14 months for patients who underwent salvage therapy and 2 months for untreated cases (P < 0.00001). A multivariate analysis showed an independent prognostic role for salvage therapy and time to relapse. Age and type of failure had no predictive value. Salvage therapy significantly improves outcome and, possibly, quality of life. As many different treatments were used conclusions cannot be made regarding an optimal treatment schedule.

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Section: Discussionmentioning

confidence: 99%

Second-line treatment for primary central nervous system lymphoma

1999

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“…No standard of care has been defined for this group of patients. Whole brain radiotherapy (WBRT) may not be appropriate because of the increased risk of late neurotoxicity in the elderly and its overall limited efficacy with a median survival time of 12 months [2]. This warrants the search for new chemotherapy regimens for these patients.…”

Section: Introductionmentioning

confidence: 99%

Primary CNS lymphoma in the elderly: temozolomide therapy and MGMT status

et al. 2009

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This retrospective series explores temozolomide monotherapy in elderly patients with primary CNS lymphoma (PCNSL) and severe comorbidities. In 17 patients (62-90 years old), complete response rate was 47%, median progression-free survival was five months and median overall survival was 21 months. Five of 17 patients (29.4%) had prolonged responses for at least 12 months and survived for more than 24 months. Three of these patients had a methylated O 6 -methylguanine-DNA methyltransferase (MGMT) promoter while the MGMT status was not assessable in the remaining two patients. Temozolomide monotherapy appears to be effective in a subgroup of elderly PCNSL patients and deserves further evaluation.

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“…Traditional whole-brain radiotherapy (WBRT) is associated with poor survival rates and severe neurotoxicity. [4][5][6][7][8] Adding CHOP to RT does not improve outcome. 4,9 Although combined modality treatment (CMT) with high-dose methotrexate (HD-MTX)-based chemotherapy and WBRT results in higher disease-free and overall survival rates, it is associated with severe neurotoxicity.…”

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confidence: 99%

High-dose thiotepa, busulfan, cyclophosphamide and ASCT without whole-brain radiotherapy for poor prognosis primary CNS lymphoma

Cheng

Forsyth

Chaudhry

et al. 2003

Bone Marrow Transplant

124

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Summary:Treatment of primary central nervous system lymphoma (PCNSL) with combined high-dose methotrexate (HD-MTX)-based chemotherapy and whole-brain radiotherapy (WBRT) is associated with severe neurotoxicity, but high relapse rates are associated with the use of either modality alone. In an attempt to improve upon these dismal results, we treated seven PCNSL patients with HD-MTX-based induction therapy followed by thiotepa, busulfan, cyclophosphamide (TBC), and autologous stem cell transplant (ASCT), without WBRT. Six of these patients had at least one of the following poor prognostic features: Karnofsky performance status (KPS) p50%, age 460 years, or relapsed disease. All but one patient tolerated the treatment well and experienced improvements in neurological function and overall performance status posttransplant. No treatment-induced neurotoxicity (dementia, ataxia, and incontinence) was observed although the follow-up is short. One early treatment-related death occurred in a patient with multiple comorbid medical conditions. The other six patients achieved a complete response (CR) after TBC and ASCT. Five patients are currently alive and relapse-free at 5, 8, 24, 36, and 42 months from diagnosis. One additional patient relapsed and died 33 months after diagnosis. Two of the seven patients received TBC/ASCT as the only treatment after disease progression following their initial chemotherapy and both remain relapse-free at the time of this report, 22 and 31 months post-TBC/ASCT. In conclusion, prolonged CR can be attained after chemotherapy-only treatment of poor prognosis PCNSL. Furthermore, this small series suggests that high-dose chemotherapy for PCNSL should include drugs that penetrate the CNS such as busulfan and thiotepa rather than standard lymphoma regimens such as BEAM.

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Non-Hodgkin's lymphoma of the brain: Can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation therapy Oncology Group (RTOG): RTOG 8315

Cited by 576 publications

References 25 publications

Second-line treatment for primary central nervous system lymphoma

Second-line treatment for primary central nervous system lymphoma

Primary CNS lymphoma in the elderly: temozolomide therapy and MGMT status

High-dose thiotepa, busulfan, cyclophosphamide and ASCT without whole-brain radiotherapy for poor prognosis primary CNS lymphoma

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