ABSTRACT
The objective of this phase II study was to evaluate the efficacy and toxicity of [CHOP] chemotherapy with intrathecal methotrexate and prophylactic cranial irradiation in patients with high-grade Non Hodgkin's lymphoma. From January 2002 to December 2002 tewenty consecutive patients with histopathologically and immunohistochemically confirmed high grade NHL with Ann Arbor stage III and IV were enrolled. ECOG performance status of 0 or 1 was required. Written informed consent was obtained from all patients. Patients with symptomatic meningeal or brain involvement were excluded from the study. Cyclophosphamide 750 mg /m2, vincristine 1.4 mg / m2 [maximum 2 mg], doxorubicin 50 mg / m2 was given I/V on D1 and prednisolone 100 mg PO was given from D1 - D5. Cycles were repeated after every 21 days. Intrathecal methotrexate was given at a dose of 12 mg once during 3rd week, twice weekly on 5th and 6th week and once during 7th week. A total dose of 1800 cGy was given to whole brain in 10 fraction s with a daily tumor dose of 180 cGy using a Cobalt 60. Common Toxicity Criteria was used for evaluation of toxicity and WHO criteria for response evaluation. All 20 patients were able to complete the planned therapy. Grade IV neutropenia was observed in 45% [9/20] of patients. Episodes of febrile neutropenia were seen in 20%[4/20]. Grade II diarrhea was seen in 25%[05/20]. 20%[4/20] had grade II cutaneous toxicity. No immediate radiation related toxicity was seen except grade II nausea and vomiting. Overall response was found in 75%[15/20] of patients, CR in 60%[12/20] and PR in 15%[03/20]. 15%[03/20] patients showed stable disease and 10%[02/20] had progressive disease. This combined modality treatment of CHOP chemotherapy with intrathecal methotrexate and prophylactic cranial irradiation has been feasible and effective with acceptable toxicity in this group of patients with high-grade Non Hodgkin's lymphoma