Primary central nervous system lymphoma

Kiewe, Philipp; Fischer, Lars; Martus, Peter; Thiel, Eckhard; Korfel, Agnieszka

doi:10.1002/cncr.23377

Cited by 22 publications

(6 citation statements)

References 23 publications

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“…These findings are in agreement with the results of Palmedo et al , who reported truly negative PET findings (confirmed by follow-up) despite the persistence of lesions on MRI in three of six patients 9. A response to initial chemotherapy as assessed by MRI has consistently been associated with the prolonged survival in PCNSL 15,16. The present findings suggest that FDG-PET might improve the response assessment and, therefore, might provide improved prognostic power compared to MRI.…”

Section: Discussionsupporting

confidence: 93%

Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

Maza¹,

Buchert²,

Brenner³

et al. 2013

Radiology and Oncology

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BackgroundPositron emission tomography (PET) with F-18-labeled fluorodeoxyglucose (FDG) provides remarkable accuracy in detection, treatment monitoring and follow-up of systemic malignant lymphoma. Its value in the management of patients with primary central nervous system lymphoma (PCNSL) is less clear.Patients and methodsIn a prospective trial, 42 FDG-PET examinations were performed in ten immunocompetent patients with newly diagnosed or recurrent PCNSL before and repeatedly during and after the treatment. Brain and whole body FDG-PET were compared to brain MRI and extra-cerebral CT, respectively.ResultsBefore the treatment, 6 of 10 patients had congruent findings on FDG-PET and MRI of the brain. Three patients had lesions on brain MRI, not detected by FDG-PET. One patient had additional FDG-PET positive lesions inconspicuous in MRI. The follow-up suggested FDG-PET to be false positive in these lesions. After the treatment, brain PET was in agreement with MRI in 6 of 8 patients. In the remaining 2 patients there were persistent lesions in brain MRI whereas FDG-uptake was reduced to normal values. In the long-term follow-up of 5 patients (63–169 weeks), 3 patients retained normal in both PET and MRI. In 2 patients a new focal pathologic FDG-uptake was detected 69 and 52 weeks after the end of the treatment. In one of these patients, recurrence was confirmed by MRI not until 9 weeks after PET.ConclusionsBrain FDG-PET may contribute valuable information for the management of PCNSL, particularly in the assessment of the treatment response. Integration of FDG-PET into prospective interventional trials is warranted to investigate prognostic and therapeutic implications.

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Section: Discussionsupporting

confidence: 93%

Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

Maza¹,

Buchert²,

Brenner³

et al. 2013

Radiology and Oncology

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“…Although MTX-based multi-drug/irradiation therapies (Table 3) are associated with PFS rates ranging from 5.6 months [24] (Cytarabine, Carmustine, etoposide, melphalan with stem cell rescue) to 11 months [25] (Lomustine, procarbazine, Cytarabine and methylprednisolone) to 77.4 months [26] (receiving steroids, cyclophosamide or etoposide and procarbazine) it is unlikely that these approaches will be the subject of randomized trials in comparison to MTX-monotherapy. The multi-drug therapies [24–37] overall survivals are 60 months [5, 27] 50 months [31] 7 months [26] similar to those we report.…”

Section: Discussionsupporting

confidence: 79%

“…The multi-drug therapies [24–37] overall survivals are 60 months [5, 27] 50 months [31] 7 months [26] similar to those we report.…”

Section: Discussionsupporting

confidence: 79%

Monotherapy with methotrexate for primary central nervous lymphoma has single agent activity in the absence of radiotherapy: a single institution cohort

et al. 2009

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We have retrospectively reviewed toxicities and response of a cohort of primary central nervous system lymphoma (PCNSL) patients treated with high dose parenteral methotrexate (MTX) monotherapy without whole brain radiation. From The Massachusetts General Hospital (MGH) Cancer Registry, active since 1946, we selected all immunocompetent patients with histologic and/or radiographic PCNSL diagnosed between 1980 and 2007. We identified the recipients of MTX with leucovorin rescue as sole therapy. No patient received radiation therapy (XRT). We analyzed this cohort for toxicity, response and patterns of recurrence. The cohort of 121 patients received on average 11 cycles of intravenous MTX at a median dose of 8 g/m2. Median interval between cycles was 10 days. After 3 months of therapy, the overall response rate was 85% (58% CR, 27% PR). The overall survival (OS) for the cohort was 7 years and progression-free survival (PFS) was 3.14 years. A trend toward a higher PFS was seen in patients who continued to receive MTX (3.48 years) every three months as compared to patients who ceased MTX after one year (2.86 years). Of 68 patients who achieved initial CR, there were 40 recurrences. Twenty-six of the 40 were re-induced with MTX as above; Sixty-nine percent again achieved CR. Eighty-one treatment-related toxicities occurred in 1316 MTX cycles. These toxicities included MRI white matter changes (N = 8) and lead to MTX cessation in 16 patients. High-dose MTX monotherapy of PCNSL is well-tolerated and provides PFS of >3 years and OS >7 years.

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“…In a recent report from the Trans-Tasman Radiation Oncology Group, O’Brien et al (13) updated their experience with PCNSL patients treated with 1 g/m 2 intravenously given for two cycles prior to WBRT (which commenced on day 15). Median survival for the 46 patients in that study was 36 months, which is comparable to the results of studies using higher doses of MTX (20–22, 25, 28–31). …”

Section: Discussionsupporting

confidence: 71%

CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma

Laack

O’Neill

Ballman

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Purpose To assess the efficacy and toxicity of chemotherapy consisting of cyclophosphamide, doxorubicin (Adriamycin), vincristine, and dexamethasone (CHOD) plus bis-chloronitrosourea (BCNU), cytosine arabinoside, and methotrexate (BVAM) followed by whole-brain irradiation (WBRT) for patients with primary central nervous system lymphoma (PCNSL). Methods and Materials Patients 70 years old and younger with newly diagnosed, biopsy-proven PCNSL received one cycle of CHOD followed by two cycles of BVAM. Patients then received WBRT, 30.6 Gy, if a complete response was evoked, or 50.4 Gy if the response was less than complete; both doses were given in 1.8-Gy daily fractions. The primary efficacy endpoint was 1-year survival. Results Thirty-six patients (19 men, 17 women) enrolled between 1995 and 2000. Median age was 60.5 years (range, 34 to 69 years). Thirty (83%) patients had baseline Eastern Cooperative Oncology Group performance scores of 0 to 1. All 36 patients were eligible for survival and response evaluations. Median time to progression was 12.3 months, and median survival was 18.5 months. The percentages of patients alive at 1, 2, and 3 years were 64%, 36%, and 33%, respectively. The best response was complete response in 10 patients and immediate progression in 7 patients. Ten (28%) patients had at least one grade 3 or higher neurologic toxicity. Conclusions This regimen did improve the survival of PCNSL patients but also caused substantial toxicity. The improvement in survival is less than that reported with high-dose methotrexate-based therapies.

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Primary central nervous system lymphoma

Cited by 22 publications

References 23 publications

Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

Monotherapy with methotrexate for primary central nervous lymphoma has single agent activity in the absence of radiotherapy: a single institution cohort

CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma

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