Preirradiation Methotrexate, Radiation Therapy and Cytosine Arabinoside Chemotherapy in Primary Central Nervous System Lymphoma; Short-term Results

ABSTRACT

PURPOSE: Primary CNS lymphoma(PCNSL) is a rare brain tumor which has poor prognosis. It is sensitive to steroid or radiation therapy(RT), but the effect is transient. Recently, many centers have tried to increase survival rate and to lower recurrence rate by combined chemotherapy. Aim of this study is to investigate the response rate, performance status change and complications after combined modality treatment in our patients with PCNSL. PATIENTS AND METHODS:Fifteen consecutive PCNSL patients were included in this study. There was no immune compromized patient. All patients underwent pre-radiation systemic MTX, 1g/m 2, plus 6 doses of intrathecal MTX at 12mg per dose. Cranial RT(WBRT 40Gy, Boost 14.4Gy) was followed by two cycles of intravenous infusion of high dose cytarabine(Ara-C). We reviewed medical records, radiologic findings for evaluation of response and performance status. RESULTS: Seven patients completed this protocol. Response rate(CR + PR/total) after radiation and after completion of combined modality were 80% and 87%, respectively. No patients showed the decrease in performance status 20 more than pre-treatment status during treatment. Four CSF cytology positive patients had undergone all negative conversion after completion of intrathecal MTX chemotherapy. CONCLUSION: The addition of chemotherapy to cranial RT for initial treatment of PCNSL had favorable response rate, CSF cytology negative conversion rate, and maintaining performance status. But, we also have observed treatment failure including life threatening compications and non-responder. Therfore, careful monitoring of medical status should warranted and neuropsychological functions should also be evaluated.