Abstract
Whole brain radiotherapy (WBRT) has long been recognized as an effective treatment for PCNSL. WBRT alone leads to tumor regression and prolongs median survival to approximately 12–18 months. However, disease returns in almost all patients. Adding chemotherapy to WBRT was the first step towards prolonging remission and survival in these patients. Through a series of studies, it is clear that high-dose methotrexate (MTX) is the single most effective agent for the treatment of PCNSL. However, whether MTX is used as a single agent or in combination with other drugs, it has the potential of causing long-term neurological sequelae when combined with WBRT, particularly in older patients. Recent data suggest that reducing the dose of WBRT may prove effective at enhancing disease control without causing neurotoxicity. Furthermore, WBRT remains an effective and important salvage therapy for those patients who recur after chemotherapy alone.
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References
Lai R, Rosenblum MK, DeAngelis LM (2002) Primary CNS lymphoma: a whole-brain disease? Neurology 59:1557–1562
Shibamoto Y, Ogino H, Hasegawa M et al (2005) Results of radiation monotherapy for primary central nervous system lymphoma in the 1990s. Int J Radiat Oncol Biol Phys 62:809–813
Nelson DF, Martz KL, Bonner H et al (1992) Non-Hodgkin’s lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 23:9–17
DeAngelis LM, Yahalom J, Heinemann MH et al (1990) Primary CNS lymphoma: combined treatment with chemotherapy and radiotherapy. Neurology 40:80–86
DeAngelis LM, Yahalom J, Thaler HT, Kher U (1992) Combined modality therapy for primary CNS lymphoma. J Clin Oncol 10:635–643
Panageas KS, Elkin EB, Ben-Porat L et al (2007) Patterns of treatment in older adults with primary central nervous system lymphoma. Cancer 110:1338–1344
Shibamoto Y, Hayabuchi N, Hiratsuka J et al (2003) Is whole-brain irradiation necessary for primary central nervous system lymphoma? Patterns of recurrence after partial-brain irradiation. Cancer 97:128–133
Lachance DH, Brizel DM, Gockerman JP et al (1994) Cyclophosphamide, doxorubicin, vincristine, and prednisone for primary central nervous system lymphoma: short-duration response and multifocal intracerebral recurrence preceding radiotherapy. Neurology 44:1721–1727
O’Neill BP, Wang CH, O’Fallon JR et al (1999) Primary central nervous system non-Hodgkin’s lymphoma (PCNSL): survival advantages with combined initial therapy? A final report of the North Central Cancer Treatment Group (NCCTG) Study 86-72-52. Int J Radiat Oncol Biol Phys 43:559–563
Schultz C, Scott C, Sherman W et al (1996) Preirradiation chemotherapy with cyclophosphamide, doxorubicin, vincristine, and dexamethasone for primary CNS lymphomas: initial report of Radiation Therapy Oncology Group protocol 88-06. J Clin Oncol 14:556–564
Abrey LE, DeAngelis LM, Yahalom J (1998) Long-term survival in primary CNS lymphoma. J Clin Oncol 16:859–863
Abrey LE, Yahalom J, DeAngelis LM (2000) Treatment for primary CNS lymphoma: the next step. J Clin Oncol 18:3144–3150
DeAngelis LM, Seiferheld W, Schold SC et al (2002) Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93-10. J Clin Oncol 20:4643–4648
Ferreri AJ, Reni M, Dell’Oro S et al (2001) Combined treatment with high-dose methotrexate, vincristine and procarbazine, without intrathecal chemotherapy, followed by consolidation radiotherapy for primary central nervous system lymphoma in immunocompetent patients. Oncology 60:134–140
O’Brien PC, Roos DE, Pratt G et al (2006) Combined modality therapy for primary central nervous system lymphoma: long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group). Int J Radiat Oncol Biol Phys 64:408–413
Omuro AM, DeAngelis LM, Yahalom J, Abrey LE (2005a) Chemoradiotherapy for primary CNS lymphoma: an intent-to-treat analysis with complete follow-up. Neurology 64:69–74
Gavrilovic IT, Hormigo A, Yahalom J et al (2006) Long-term follow-up of high-dose methotrexate-based therapy with and without whole brain irradiation for newly diagnosed primary CNS lymphoma. J Clin Oncol 24:4570–4574
Bessell EM, Graus F, Lopez-Guillermo A et al (2004) Primary non-Hodgkin’s lymphoma of the CNS treated with CHOD/BVAM or BVAM chemotherapy before radiotherapy: long-term survival and prognostic factors. Int J Radiat Oncol Biol Phys 59:501–508
Poortmans PM, Kluin-Nelemans HC, Haaxma-Reiche H et al (2003) High-dose methotrexate-based chemotherapy followed by consolidating radiotherapy in non-AIDS-related primary central nervous system lymphoma: European Organization for Research and Treatment of Cancer lymphoma group phase II trial 20962. J Clin Oncol 21:4483–4488
Khan RB, Shi W, Thaler HT et al (2002) Is intrathecal methotrexate necessary in the treatment of primary CNS lymphoma? J Neurooncol 58:175–178
Omuro AM, Ben-Porat LS, Panageas KS et al (2005b) Delayed neurotoxicity in primary central nervous system lymphoma. Arch Neurol 62:1595–1600
Bessell EM, Lopez-Guillermo A, Villa S et al (2002) Importance of radiotherapy in the outcome of patients with primary CNS lymphoma: an analysis of the CHOD/BVAM regimen followed by two different radiotherapy treatments. J Clin Oncol 20:231–236
Fisher B, Seiferheld W, Schultz C et al (2005) Secondary analysis of Radiation Therapy Oncology Group study (RTOG) 9310: an intergroup phase II combined modality treatment of primary central nervous system lymphoma. J Neurooncol 74:201–205
Shah GD, Yahalom J, Correa D et al (2007) Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 25:4730–4735
Correa DD, Rocco-Donovan M, DeAngelis LM et al (2009) Prospective cognitive follow-up in primary CNS lymphoma patients treated with chemotherapy and reduced-dose radiotherapy. J Neurooncol 91:315–321
Nguyen PL, Chakravarti A, Finkelstein DM et al (2005) Results of whole-brain radiation as salvage of methotrexate failure for immunocompetent patients with primary CNS lymphoma. J Clin Oncol 23:1507–1513
Hottinger AF, DeAngelis LM, Yahalom J, Abrey LE (2007) Salvage whole brain radiotherapy for recurrent or refractory primary CNS lymphoma. Neurology 69:1178–1182
Glass J, Gruber ML, Cher L et al (1994) Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg 81:188–195
O’Brien P, Roos D, Pratt G et al (2000) Phase II multicenter study of brief single-agent methotrexate followed by irradiation in primary CNS lymphoma. J Clin Oncol 18:519–526
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DeAngelis, L.M., Yahalom, J. (2012). Treatment of Primary Central Nervous System Lymphoma with Cranial Irradiation and Combined Modality Therapy. In: Batchelor, T., DeAngelis, L. (eds) Lymphoma and Leukemia of the Nervous System. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7668-0_7
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