Improved survival with combined chemo-radiotherapy in primary central nervous system lymphoma

Primary CNS lymphoma [PCNSL] is an aggressive primary brain tumor. Cranial irradiation alone rarely results in long term disease control or prolonged survival. We retrospectively analyzed data on the effect of adding high-dose methotrexate [HDMTX] prior to whole brain irradiation [WBI]. All patients with PCNSL diagnosed and managed during 1991-2004 were identified and demographic characteristics, prognostic factors, treatment and outcome were reviewed. Of 62 patients, 10 were excluded [4 had WBI < 40 Gy and 6 had no treatment]. Radiation alone was considered curative with a dose > 40 Gy. Combined modality therapy included 3-4 cycles of HDMTX [3g/m2] followed by WBI. Of 52 patients analyzed for outcome, 36 had WBI [dose > 40 Gy], 16 received 3-4 cycles of HDMTX followed by WBI [combined modality therapy [CMT]]. Median age was 48.2 years; 42 years in the CMT group, 51 years in WBI. Patient characteristics were comparable between two groups except for higher multifocal tumor in the CMT group [92% vs. x22%, P=.029]. Median follow up was 12.83 +/- 6.4 months. The hazard ration for an event was 0.64 [95% CI, 0.52-0.98] and for death 0.58 [95% CI, 0.48-0.92], both in favor of CMT. Univariate regression analysis using one-way analyses of variance [ANOVA] and multivariate Cox regression analysis for prognostic factors including age [< 60 vs. >60], ECOG PS [0-2 vs. 3-4], extent of surgery [biopsy vs. debulking], solitary vs multifocal tumor and dose of radiation therapy [>50Gy vs. >50 Gy] failed to identify any prognostic factor. This retrospecitive comparison supports phase II trial results that indicate that high-dose methotrexate followed by WBI in PCNSL improves outcome

Whole body [18]F-FDG PET predicts progression free and overall survival in squamous cell carcinoma of the esophagus: results of a prospective trial

[18]F-FDG PET yields physiologic information that allows for identifying cancer based on altered tissue metabolism. The aim of this study was to prospectively validate the predictive value of positron emission tomography [PET] in squamous cell carcinoma [SCC] of the esophagus treated by pre-operative chemotherapy followed by esophagectomy. Prospective efficacy and toxicity study of patients enrolled between January 1999 and September 2003. Twenty-one patients with SCC of the esophagus who were potentially resectable underwent [18]F-FDG PET imaging before the first cycle of neoadjuvant chemotherapy and at least 14 days after the third cycle. A patient was classified as a metabolic responder when the metabolic activity of the primary tumor as measured by the maximum standardized uptake values had decreased by 50% or more at the time of the second [18]F-FDG PET. The median age of the study cohort was 60 years with a range of 39-70 years; 12 patients were males and 9 were females.[18]F-FDG PET had increased activity in the primary tumor in all patients. Metabolic response occurred in 14/21 patients [66%], while 7/21 [33%] patients did not show a metabolic response. Metabolic responders had a high clinical response rate [92%], a median progression free survival [PFS] of 16.4 months and a median overall survival [OS] of 35.3 months. In contrast, prognosis was poor for metabolic non-responders with a clinical response rate of 42% [P=.025], a median PFS of 7.13 months [P=.032] and median OS of 12 months [P=.038]. Our results demonstrate that changes in tumor metabolic activity after neoadjuvant chemotherapy predicts PFS and OS in esophageal SCC patients