The treatment of primary central nervous system lymphoma in 122 immunocompetent patients: a population-based study of successively treated cohorts from the British Colombia Cancer Agency.
Cancer
; 103(5): 1008-17, 2005 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-15651059
ABSTRACT
BACKGROUND:
The objective of this study was to evaluate the clinical outcome of a population-based cohort of immunocompetent patients with primary central nervous system lymphoma (PCNSL) treated with 3 different strategies over 13 years.METHODS:
One hundred twenty-two consecutive patients (median age, 66 years) with PCNSL were identified. Three treatment strategies were employed 1) whole-brain irradiation with (from January, 1990, to June, 1991) or without (from April, 1995, to December, 1999) cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-type chemotherapy (n=50 patients); 2) combined-modality therapy, including 1 g/m2 methotrexate plus whole-brain irradiation (from July, 1991, to March, 1995; n=34 patients); and 3) 8 g/m2 methotrexate alone (from January, 2000, to March, 2003) with whole-brain irradiation reserved for those with progressive disease (n=38 patients). Treatment failure was defined as progressive disease, disease recurrence, death from toxicity or lymphoma, or toxicity that necessitated a change in primary treatment.RESULTS:
The median failure-free survival was 7 months, and the median overall survival (OS) was 17 months. The median OS was similar in all 3 eras. In this population-based analysis, one-third of patients did not receive the treatment strategy of the era. Therefore, the data also were analyzed by treatment received. On multivariate analysis (including era of treatment), 3 factors-age > 60 years, lactate dehydrogenase > normal, and omission of methotrexate-were associated significantly with poorer OS (hazard ratio 2.3, 2.2, and 2.3, respectively).CONCLUSIONS:
Outcomes for a general population with PCNSL remained constant despite different treatment strategies over three eras. For the two-thirds of patients who could receive potentially curative treatment, age, lactate dehydrogenase level, and receipt of > or = 1 g/m2 methotrexate appeared to be important determinants of OS.
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Base de dados:
MEDLINE
Assunto principal:
Vincristina
/
Prednisona
/
Protocolos de Quimioterapia Combinada Antineoplásica
/
Doxorrubicina
/
Metotrexato
/
Irradiação Craniana
/
Neoplasias do Sistema Nervoso Central
/
Ciclofosfamida
/
Linfoma
País/Região como assunto:
America do sul
/
Colombia
Idioma:
En
Ano de publicação:
2005
Tipo de documento:
Article
País de afiliação:
Canadá