Methotrexate based chemotherapy and deferred radiotherapy for primary central nervous system lymphoma (PCNSL): Single institution experience

A. Silvani, A. Salmaggi, M. Eoli, E. Lamperti, G. Broggi, C. E. Marras, L. Fariselli, I. Milanesi, A. Fiumani, P. Gaviani, A. Erbetta, A. R. Giovagnoli, B. Pollo, A. Botturi, A. Boiardi

Research output: Contribution to journalArticle

Abstract

In the following study, we present our experience in the treatment of PCNSL patients using a multi-step schedule combining chemotherapy and deferred radiotherapy. Patients were treated with two modified M-BACOD cycles and then differently according to radiological response For PR, SD and PD patients, chemotherapy was interrupted and radiotherapy initiated immediately (45 Gy Whole-brain RT). With CR patients, chemotherapy was continued with a combination of HMTX, VCZ, PCB and HD Ara-C up to a total of nine cycles. In 36 patients suitable for evaluation (2 patients had undergone tumour resection): 69.4% (25 of 36) had a complete response (CR), 19.4% (7 of 36) had a partial response(PR), 8.3% (3 of 36) had stable disease(SD), and 2.7% (one of 36) had progressive disease (PD). The PR, SD and PD patients were immediately treated by radiotherapy. In this cohort of patients, we observed 6 CR, 4 PR and 2 PD, respectively, following radiotherapy. At first relapse, a total of 16 CR patients were treated by radiotherapy for a total dose of 45 Gy. The OS was 42.1 months for the entire group of patients. In CR patients treated at the moment of recurrence by salvage radiotherapy, the TTP (time lasting from histological diagnosis until recurrence of disease before RT) was 28.3 months, with a 43.4% of disease free patients observed at 2 years. The median disease-free time observed after complete response to radiotherapy was 10.5 months. In 16 patients (34%), further progression of disease was observed following radiotherapy. Two patients developed extra-CNS disease in the breast and testis. When taking into account the patients with radiotherapy delayed at recurrence, the OS was 48 months and the survival rates were 70% and 60% at 2 years and 5 years, respectively.

Original languageEnglish
Pages (from-to)273-279
Number of pages7
JournalJournal of Neuro-Oncology
Volume82
Issue number3
DOIs
Publication statusPublished - May 2007

Fingerprint

Methotrexate
Lymphoma
Radiotherapy
Central Nervous System
Drug Therapy
Recurrence
Central Nervous System Diseases
Polychlorinated Biphenyls
Cytarabine
Disease Progression
Testis
Appointments and Schedules
Breast
Survival Rate

Keywords

  • Chemotherapy
  • HD-Ara-C
  • Methotrexate
  • Primary Central Nervous System Lymphoma

ASJC Scopus subject areas

  • Cancer Research
  • Clinical Neurology
  • Oncology
  • Neuroscience(all)

Cite this

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title = "Methotrexate based chemotherapy and deferred radiotherapy for primary central nervous system lymphoma (PCNSL): Single institution experience",
abstract = "In the following study, we present our experience in the treatment of PCNSL patients using a multi-step schedule combining chemotherapy and deferred radiotherapy. Patients were treated with two modified M-BACOD cycles and then differently according to radiological response For PR, SD and PD patients, chemotherapy was interrupted and radiotherapy initiated immediately (45 Gy Whole-brain RT). With CR patients, chemotherapy was continued with a combination of HMTX, VCZ, PCB and HD Ara-C up to a total of nine cycles. In 36 patients suitable for evaluation (2 patients had undergone tumour resection): 69.4{\%} (25 of 36) had a complete response (CR), 19.4{\%} (7 of 36) had a partial response(PR), 8.3{\%} (3 of 36) had stable disease(SD), and 2.7{\%} (one of 36) had progressive disease (PD). The PR, SD and PD patients were immediately treated by radiotherapy. In this cohort of patients, we observed 6 CR, 4 PR and 2 PD, respectively, following radiotherapy. At first relapse, a total of 16 CR patients were treated by radiotherapy for a total dose of 45 Gy. The OS was 42.1 months for the entire group of patients. In CR patients treated at the moment of recurrence by salvage radiotherapy, the TTP (time lasting from histological diagnosis until recurrence of disease before RT) was 28.3 months, with a 43.4{\%} of disease free patients observed at 2 years. The median disease-free time observed after complete response to radiotherapy was 10.5 months. In 16 patients (34{\%}), further progression of disease was observed following radiotherapy. Two patients developed extra-CNS disease in the breast and testis. When taking into account the patients with radiotherapy delayed at recurrence, the OS was 48 months and the survival rates were 70{\%} and 60{\%} at 2 years and 5 years, respectively.",
keywords = "Chemotherapy, HD-Ara-C, Methotrexate, Primary Central Nervous System Lymphoma",
author = "A. Silvani and A. Salmaggi and M. Eoli and E. Lamperti and G. Broggi and Marras, {C. E.} and L. Fariselli and I. Milanesi and A. Fiumani and P. Gaviani and A. Erbetta and Giovagnoli, {A. R.} and B. Pollo and A. Botturi and A. Boiardi",
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T1 - Methotrexate based chemotherapy and deferred radiotherapy for primary central nervous system lymphoma (PCNSL)

T2 - Single institution experience

AU - Silvani, A.

AU - Salmaggi, A.

AU - Eoli, M.

AU - Lamperti, E.

AU - Broggi, G.

AU - Marras, C. E.

AU - Fariselli, L.

AU - Milanesi, I.

AU - Fiumani, A.

AU - Gaviani, P.

AU - Erbetta, A.

AU - Giovagnoli, A. R.

AU - Pollo, B.

AU - Botturi, A.

AU - Boiardi, A.

PY - 2007/5

Y1 - 2007/5

N2 - In the following study, we present our experience in the treatment of PCNSL patients using a multi-step schedule combining chemotherapy and deferred radiotherapy. Patients were treated with two modified M-BACOD cycles and then differently according to radiological response For PR, SD and PD patients, chemotherapy was interrupted and radiotherapy initiated immediately (45 Gy Whole-brain RT). With CR patients, chemotherapy was continued with a combination of HMTX, VCZ, PCB and HD Ara-C up to a total of nine cycles. In 36 patients suitable for evaluation (2 patients had undergone tumour resection): 69.4% (25 of 36) had a complete response (CR), 19.4% (7 of 36) had a partial response(PR), 8.3% (3 of 36) had stable disease(SD), and 2.7% (one of 36) had progressive disease (PD). The PR, SD and PD patients were immediately treated by radiotherapy. In this cohort of patients, we observed 6 CR, 4 PR and 2 PD, respectively, following radiotherapy. At first relapse, a total of 16 CR patients were treated by radiotherapy for a total dose of 45 Gy. The OS was 42.1 months for the entire group of patients. In CR patients treated at the moment of recurrence by salvage radiotherapy, the TTP (time lasting from histological diagnosis until recurrence of disease before RT) was 28.3 months, with a 43.4% of disease free patients observed at 2 years. The median disease-free time observed after complete response to radiotherapy was 10.5 months. In 16 patients (34%), further progression of disease was observed following radiotherapy. Two patients developed extra-CNS disease in the breast and testis. When taking into account the patients with radiotherapy delayed at recurrence, the OS was 48 months and the survival rates were 70% and 60% at 2 years and 5 years, respectively.

AB - In the following study, we present our experience in the treatment of PCNSL patients using a multi-step schedule combining chemotherapy and deferred radiotherapy. Patients were treated with two modified M-BACOD cycles and then differently according to radiological response For PR, SD and PD patients, chemotherapy was interrupted and radiotherapy initiated immediately (45 Gy Whole-brain RT). With CR patients, chemotherapy was continued with a combination of HMTX, VCZ, PCB and HD Ara-C up to a total of nine cycles. In 36 patients suitable for evaluation (2 patients had undergone tumour resection): 69.4% (25 of 36) had a complete response (CR), 19.4% (7 of 36) had a partial response(PR), 8.3% (3 of 36) had stable disease(SD), and 2.7% (one of 36) had progressive disease (PD). The PR, SD and PD patients were immediately treated by radiotherapy. In this cohort of patients, we observed 6 CR, 4 PR and 2 PD, respectively, following radiotherapy. At first relapse, a total of 16 CR patients were treated by radiotherapy for a total dose of 45 Gy. The OS was 42.1 months for the entire group of patients. In CR patients treated at the moment of recurrence by salvage radiotherapy, the TTP (time lasting from histological diagnosis until recurrence of disease before RT) was 28.3 months, with a 43.4% of disease free patients observed at 2 years. The median disease-free time observed after complete response to radiotherapy was 10.5 months. In 16 patients (34%), further progression of disease was observed following radiotherapy. Two patients developed extra-CNS disease in the breast and testis. When taking into account the patients with radiotherapy delayed at recurrence, the OS was 48 months and the survival rates were 70% and 60% at 2 years and 5 years, respectively.

KW - Chemotherapy

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KW - Methotrexate

KW - Primary Central Nervous System Lymphoma

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