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Neurology ; 58(10): 1513-20, 2002 May 28.
Article in English | MEDLINE | ID: mdl-12034789

ABSTRACT

OBJECTIVE: To characterize the therapeutic variables correlated to outcome in 370 patients with primary CNS lymphoma. METHODS: Planned treatment was radiotherapy (RT) in 98 patients, chemotherapy (CHT) in 32, RT followed by CHT in 36, and CHT followed by RT in 197 patients. High-dose methotrexate (HD-MTX; 1 to 8 g/m2) was used in 169 patients and intrathecal CHT in 109. RESULTS: One hundred sixteen patients are alive (median follow-up 24 months), with a 2-year overall survival of 37%. Patients treated with CHT followed by RT had improved survival with respect to patients treated with RT alone. Patients receiving HD-MTX-based primary CHT survived longer than those treated with other drugs. HD-MTX associated with other cytostatics, in particular HD-cytarabine, produced better results than HD-MTX alone. No correlation between MTX dose and survival was found. In patients receiving HD-MTX, consolidation RT or intrathecal CHT did not improve survival. Age, performance status, lactate dehydrogenase serum level, CSF protein level, site of disease, and use of HD-MTX were all predictors of survival. CONCLUSIONS: Combination CHT-RT is superior to RT alone. Patients treated with primary CHT containing HD-MTX exhibited improved survival. In these patients, the addition of HD-cytarabine was associated with a better survival, whereas intrathecal CHT was not correlated to outcome. RT may be unnecessary in patients achieving complete remission after receiving HD-MTX-based primary CHT.


Subject(s)
Central Nervous System Neoplasms/drug therapy , Central Nervous System Neoplasms/radiotherapy , Lymphoma/drug therapy , Lymphoma/radiotherapy , Adolescent , Adult , Aged , Aged, 80 and over , Central Nervous System Neoplasms/mortality , Chi-Square Distribution , Confidence Intervals , Female , Humans , Lymphoma/mortality , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Proportional Hazards Models , Retrospective Studies , Survival Analysis
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