Chemotherapy is effective as early treatment for primary central nervous system lymphoma

Amerigo Boiardi, Antonio Silvani, Annalisa Pozzi, Laura Fariselli, Giovanni Broggi, Andrea Salmaggi

Research output: Contribution to journalArticle

Abstract

Primary central nervous system lymphoma (PCNSL) is a lymphoma arising within the brain or spinal cord in the absence of evident localisation outside the central nervous system (CNS). Poor results in the management of relapsed PCNSL justify the need for vigorous initial therapeutic regimens, and chemotherapy should not be reserved for recurrent disease. Chemotherapy (MBACOD scheme) was delivered prior to irradiation in a group of 20 PCNSL patients, another 8 PCNSL patients underwent radiotherapy only, and the overall survival was evaluated. Computed tomography (CT) images in the group of patients treated with chemotherapy, showed there to be 70% complete responders (CR), 15% non-responders (NR) and 15% partial responders (PR). Half of the CR were scheduled for radiotherapy only at tumour recurrence. The median disease-free period and survival time of the whole group treated with early chemotherapy followed by radiotherapy were 24 and 32 months, respectively, but in the subgroup of CR (70%), taking into account also the patients not yet receiving radiotherapy, these were 38 and 48 months, respectively. The disease-free and survival times in the group of CR (75%) of patients treated with radiotherapy only were 13 and 18 months, respectively. At tumour recurrence, CR to chemotherapy had a second disease-free period longer than 2 years after radiotherapy. Our data support the belief that in scheduling the treatment of PCNSL after histological diagnosis, the first step is to devise high-dose chemotherapy with drugs able to cross an intact blood-brain barrier. The results of our primary approach with early chemotherapy in PCNSL support a consensus to continue chemotherapy until tumour recurrence, and only at that event to initiate radiotherapy. It is a challenge and an option worthy of continuing investigation.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalJournal of Neurology
Volume246
Issue number1
DOIs
Publication statusPublished - 1999

Fingerprint

Lymphoma
Central Nervous System
Radiotherapy
Drug Therapy
Therapeutics
Recurrence
Disease-Free Survival
Neoplasms
Blood-Brain Barrier
Spinal Cord
Tomography
Survival
Brain
Pharmaceutical Preparations

Keywords

  • Central nervous system (CNS) lymphoma
  • Chemotherapy
  • Methotrexate

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Chemotherapy is effective as early treatment for primary central nervous system lymphoma. / Boiardi, Amerigo; Silvani, Antonio; Pozzi, Annalisa; Fariselli, Laura; Broggi, Giovanni; Salmaggi, Andrea.

In: Journal of Neurology, Vol. 246, No. 1, 1999, p. 31-37.

Research output: Contribution to journalArticle

Boiardi, Amerigo ; Silvani, Antonio ; Pozzi, Annalisa ; Fariselli, Laura ; Broggi, Giovanni ; Salmaggi, Andrea. / Chemotherapy is effective as early treatment for primary central nervous system lymphoma. In: Journal of Neurology. 1999 ; Vol. 246, No. 1. pp. 31-37.
@article{ff13b3803539456b9dfef1210d50b3fd,
title = "Chemotherapy is effective as early treatment for primary central nervous system lymphoma",
abstract = "Primary central nervous system lymphoma (PCNSL) is a lymphoma arising within the brain or spinal cord in the absence of evident localisation outside the central nervous system (CNS). Poor results in the management of relapsed PCNSL justify the need for vigorous initial therapeutic regimens, and chemotherapy should not be reserved for recurrent disease. Chemotherapy (MBACOD scheme) was delivered prior to irradiation in a group of 20 PCNSL patients, another 8 PCNSL patients underwent radiotherapy only, and the overall survival was evaluated. Computed tomography (CT) images in the group of patients treated with chemotherapy, showed there to be 70{\%} complete responders (CR), 15{\%} non-responders (NR) and 15{\%} partial responders (PR). Half of the CR were scheduled for radiotherapy only at tumour recurrence. The median disease-free period and survival time of the whole group treated with early chemotherapy followed by radiotherapy were 24 and 32 months, respectively, but in the subgroup of CR (70{\%}), taking into account also the patients not yet receiving radiotherapy, these were 38 and 48 months, respectively. The disease-free and survival times in the group of CR (75{\%}) of patients treated with radiotherapy only were 13 and 18 months, respectively. At tumour recurrence, CR to chemotherapy had a second disease-free period longer than 2 years after radiotherapy. Our data support the belief that in scheduling the treatment of PCNSL after histological diagnosis, the first step is to devise high-dose chemotherapy with drugs able to cross an intact blood-brain barrier. The results of our primary approach with early chemotherapy in PCNSL support a consensus to continue chemotherapy until tumour recurrence, and only at that event to initiate radiotherapy. It is a challenge and an option worthy of continuing investigation.",
keywords = "Central nervous system (CNS) lymphoma, Chemotherapy, Methotrexate",
author = "Amerigo Boiardi and Antonio Silvani and Annalisa Pozzi and Laura Fariselli and Giovanni Broggi and Andrea Salmaggi",
year = "1999",
doi = "10.1007/s004150050302",
language = "English",
volume = "246",
pages = "31--37",
journal = "Journal of Neurology",
issn = "0340-5354",
publisher = "Dr. Dietrich Steinkopff Verlag GmbH and Co. KG",
number = "1",

}

TY - JOUR

T1 - Chemotherapy is effective as early treatment for primary central nervous system lymphoma

AU - Boiardi, Amerigo

AU - Silvani, Antonio

AU - Pozzi, Annalisa

AU - Fariselli, Laura

AU - Broggi, Giovanni

AU - Salmaggi, Andrea

PY - 1999

Y1 - 1999

N2 - Primary central nervous system lymphoma (PCNSL) is a lymphoma arising within the brain or spinal cord in the absence of evident localisation outside the central nervous system (CNS). Poor results in the management of relapsed PCNSL justify the need for vigorous initial therapeutic regimens, and chemotherapy should not be reserved for recurrent disease. Chemotherapy (MBACOD scheme) was delivered prior to irradiation in a group of 20 PCNSL patients, another 8 PCNSL patients underwent radiotherapy only, and the overall survival was evaluated. Computed tomography (CT) images in the group of patients treated with chemotherapy, showed there to be 70% complete responders (CR), 15% non-responders (NR) and 15% partial responders (PR). Half of the CR were scheduled for radiotherapy only at tumour recurrence. The median disease-free period and survival time of the whole group treated with early chemotherapy followed by radiotherapy were 24 and 32 months, respectively, but in the subgroup of CR (70%), taking into account also the patients not yet receiving radiotherapy, these were 38 and 48 months, respectively. The disease-free and survival times in the group of CR (75%) of patients treated with radiotherapy only were 13 and 18 months, respectively. At tumour recurrence, CR to chemotherapy had a second disease-free period longer than 2 years after radiotherapy. Our data support the belief that in scheduling the treatment of PCNSL after histological diagnosis, the first step is to devise high-dose chemotherapy with drugs able to cross an intact blood-brain barrier. The results of our primary approach with early chemotherapy in PCNSL support a consensus to continue chemotherapy until tumour recurrence, and only at that event to initiate radiotherapy. It is a challenge and an option worthy of continuing investigation.

AB - Primary central nervous system lymphoma (PCNSL) is a lymphoma arising within the brain or spinal cord in the absence of evident localisation outside the central nervous system (CNS). Poor results in the management of relapsed PCNSL justify the need for vigorous initial therapeutic regimens, and chemotherapy should not be reserved for recurrent disease. Chemotherapy (MBACOD scheme) was delivered prior to irradiation in a group of 20 PCNSL patients, another 8 PCNSL patients underwent radiotherapy only, and the overall survival was evaluated. Computed tomography (CT) images in the group of patients treated with chemotherapy, showed there to be 70% complete responders (CR), 15% non-responders (NR) and 15% partial responders (PR). Half of the CR were scheduled for radiotherapy only at tumour recurrence. The median disease-free period and survival time of the whole group treated with early chemotherapy followed by radiotherapy were 24 and 32 months, respectively, but in the subgroup of CR (70%), taking into account also the patients not yet receiving radiotherapy, these were 38 and 48 months, respectively. The disease-free and survival times in the group of CR (75%) of patients treated with radiotherapy only were 13 and 18 months, respectively. At tumour recurrence, CR to chemotherapy had a second disease-free period longer than 2 years after radiotherapy. Our data support the belief that in scheduling the treatment of PCNSL after histological diagnosis, the first step is to devise high-dose chemotherapy with drugs able to cross an intact blood-brain barrier. The results of our primary approach with early chemotherapy in PCNSL support a consensus to continue chemotherapy until tumour recurrence, and only at that event to initiate radiotherapy. It is a challenge and an option worthy of continuing investigation.

KW - Central nervous system (CNS) lymphoma

KW - Chemotherapy

KW - Methotrexate

UR - http://www.scopus.com/inward/record.url?scp=0032965751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032965751&partnerID=8YFLogxK

U2 - 10.1007/s004150050302

DO - 10.1007/s004150050302

M3 - Article

C2 - 9987711

AN - SCOPUS:0032965751

VL - 246

SP - 31

EP - 37

JO - Journal of Neurology

JF - Journal of Neurology

SN - 0340-5354

IS - 1

ER -