Chemotherapy is increasingly being used as an upfront treatment for newly diagnosed primary central nervous system lymphomas (PCNSL), with whole brain radiotherapy (WBRT) as a second line treatment. Objective. To assess the value of WBRT as a salvage treatment in patients with PCNSL unresponsive to or progressive after methotrexate (MTX)-based chemotherapy. Design/methods. We report 19 patients with a biopsy-proven PCNSL, who were treated with salvage WBRT (median dose 50 Gy) because their disease was unresponsive to or progressive after an induction chemotherapy regimen, including both intravenous and intrathecal MTX and cytarabine. There were 10 males and 9 females, with a median age of 48 years and a median Karnofsky score of 60 (range 40-100). Lesions were multiple in 60% of patients and single in 40%. Response to RT was evaluated on MRI performed 4-6 weeks after the end of treatment, basing on conventional criteria of Macdonald. Results. Responses to salvage RT were as follows: CR 7/19 (37%) and PR 7/19 (37%), with an overall response rate of 74%. Two patients had stable disease (10%) and 3/19 (16%) progressive disease. Most patients who responded to WBRT showed neurological improvement. Time to tumor progression is 13 months (4.5-30 months), with a median survival of 17 months (5-36 months). One long surviving patient developed dementia. Conclusions. Salvage WBRT is effective in a significant proportion of patients in whom disease is unresponsive to or progressive after chemotherapy.
|Issue number||4 SUPPL.|
|Publication status||Published - 2000|
ASJC Scopus subject areas
- Clinical Neurology