Is There a Role for Radiotherapy in the Primary Management of Primary Central Nervous System Lymphoma? A Single-centre Case Series

Muirhead, R.; Murray, Eleanor; Bell, Stephen; Stewart, William; James, Allan

doi:10.1016/j.clon.2013.04.007

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…The median OS of the 61 patients who were included in this study was 41.6 months. The OS of patients in this study is supported by the results of other published series using HD-MTX with or without WBRT for unselected patients with PCNSL where median OS values have been reported as between 8 and 42 months (Hodson et al 2005 ; Silvani et al 2007 ; Kiewe et al 2008 ; Muirhead et al 2013 ; Hart et al 2014 ). In our intent-to-treat patient population, the patients in their seventh decade had a median OS of 67.6 months, and patients in their eighth decade had the shortest median OS of 14.4 months.…”

Section: Discussionsupporting

confidence: 83%

Response-adapted treatment with upfront high-dose chemotherapy followed by autologous stem-cell transplantation rescue or consolidation phase high-dose methotrexate for primary central nervous system lymphoma: a long-term mono-center study

et al. 2016

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Treatment regimens for primary central nervous system lymphoma (PCNSL) include high-dose methotrexate (HD-MTX)-based chemotherapy, with or without radiotherapy and are based on studies of selected patient groups. This retrospective study assessed a consistent strategy of response-adapted protocol applied for patients including age >65 years in a cancer center for 10 years longitudinally. Case notes were studied of 61 consecutively treated patients with PCNSL histologically diagnosed between 2003 and 2013. Clinical follow-up during and after treatment included neurologic examination and magnetic resonance imaging. Of the patients studied, 14.8 % (9/61) were clinically unfit for chemotherapy; the remaining 85.2 % (52/61) of patients were treated with HD-MTX. Of these patients, 58 % (30/52) achieved an initial complete response, with a median survival of 100.1 months. Of these response-adapted patients, 33 % (10/30) were <65 years and were treated with upfront high-dose chemotherapy and autologous stem-cell transplantation (HDC-ASCT). The remaining response-adapted patients included 53 % (16/30) who were ≥65 years underwent consolidation with HD-MTX, and 14 % (4/30) who chose radiotherapy. The median survival of patients with HDC-ASCT had not yet been reached compared with 67.6 months for patients with HD-MTX consolidation treatment (p = 0.26). At the end of the study, 75 % (39/52) of patients had died mainly owing to progression or relapse of PCNSL. Multivariate analysis showed that age younger than 65 years (p = 0.02) and complete response for up-front HD-MTX (p = 0.001) were independent prognostic indicators of overall survival. In conclusion, this single-center retrospective clinical study has shown that treatment of PCNSL with upfront HDC-ASCT and consolidation phase HD-MTX monotherapy may be feasible, even for elderly patients in a routine clinical setting, using the three-step selection by eligibility and response to initial HD-MTX, and age threshold of 65 years for ASCT.

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Section: Discussionsupporting

confidence: 83%

Response-adapted treatment with upfront high-dose chemotherapy followed by autologous stem-cell transplantation rescue or consolidation phase high-dose methotrexate for primary central nervous system lymphoma: a long-term mono-center study

et al. 2016

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“…Later, some other authors reported similar cases and proposed the sentinel lesion hypothesis, but the pathology of prophase lesion and PCNSL are different. 6,12,16,17 We believe that prophase inflammation and subsequent PCNSL are two other diseases rather than two stages of the same disease. 6,11,12,14 Most of these lymphocytes that enter the nervous tissue are T lymphocytes.…”

Section: Discussionmentioning

confidence: 97%

“…3,4 Whole-brain radiotherapy has been gradually abandoned due to neurotoxicity, but a few patients with lymphoma who are not sensitive to chemotherapy still need whole-brain radiation as adjuvant therapy. 3,17 CD4 T lymphocyte infiltration mainly occurs in the immune response after infection and is a normal immunologic function. CD5 T lymphocyte infiltration occurs mainly in autoimmune diseases, suggesting abnormal immunologic function.…”

Section: Discussionmentioning

confidence: 99%

Could Cerebral Inflammatory Lesions be the Cellular Origin of Primary Central Nervous System Lymphoma?

Ma,

Wang,

Chen

et al. 2024

Journal of Craniofacial Surgery

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Introduction: Primary central nervous system lymphoma (PCNSL) presents a diagnostic enigma due to the inherent absence of lymphoid tissue in the central nervous system (CNS). The hypothesis posits that lymphocytes infiltrating the CNS during inflammatory responses could represent a cellular source for PCNSL, challenging traditional understandings of its etiology. Patient concerns: In 2 illustrative cases, patients presented with neurological symptoms initially misdiagnosed as encephalitis and demyelinating disease, respectively. These diagnoses were established based on clinical assessments and initial biopsy findings. Diagnosis: Subsequent biopsies, conducted months after the first signs of disease, confirmed the diagnosis of PCNSL in both patients. Identifying CD20-positive tumor cells was pivotal, indicating a B-cell lymphoma origin. Interventions: Treatment strategies included high-dose methotrexate chemotherapy for both patients. In addition, the second patient underwent adjuvant whole-brain radiotherapy after the chemotherapy regimen. Outcomes: The therapeutic approach significantly reduced tumor size in both cases, with no evidence of recurrence observed during the follow-up period. This outcome underscores the potential efficacy of the chosen interventions. Conclusion: In response to inflammatory lesions, lymphocyte infiltration into the CNS may serve as a pivotal origin for tumor cells in PCNSL. These cases highlight the complexity of diagnosing CNS disorders and suggest that various forms of encephalitis in the early stages could influence the prognosis of lymphoma. This insight into the cellular origins and treatment responses of PCNSL contributes to a broader understanding of its pathophysiology and management.

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“…However, due to toxic side effects, it is recommended that elderly patients (>60 years old) should receive chemotherapy alone (43,44). A study conducted by Muirhead et al (45) revealed that for patients who were not able to tolerate large-dose chemotherapy, 3-year survival rates of salvage radiotherapy were increased compared with that of the second-line chemotherapy (60 vs. 33%). Salvage radiotherapy may be a choice for young patients with recurrent/refractory PCNSL (7).…”

Section: Discussionmentioning

confidence: 99%

Curative effect of methotrexate combined with teniposide in the treatment of primary central nervous system lymphoma

Wang

Huang

et al. 2020

Oncol Lett

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The present study aimed to investigate the curative effect of high-dose methotrexate (HD-MTX) combined with teniposide (Vm26) vs. HD-MTX alone in the treatment of primary central nervous system lymphoma (PCNSL), in order to provide data for assisting decisions associated with clinical treatment. Data from 56 patients with PCNSL admitted in Shanghai Huashan Hospital (Shanghai, China) from January 2009 to December 2014 were included into the present study. Clinical data, curative effects and prognosis of patients in these two groups were retrospectively analyzed using SPSS 20 statistical software. In the HD-MTX+Vm26 group, 12 patients (42.85%) achieved complete remission (CR) and 10 patients (35.71%) achieved partial remission (PR), while in the HD-MTX group 7 patients (25%) achieved CR and 11 patients (39.29%) achieved PR (P=0.158). The median progression-free survival (PFS) time was 22 months in the HD-MTX+Vm26 group and 12 months in the HD-MTX group (P=0.019). The median overall survival time was 57 months in the HD-MTX+Vm26 group, and 28 months in the HD-MTX group (P=0.013). Compared with HD-MTX alone, the combined treatment of HD-MTX+Vm26 had an improved curative effect in the treatment of PCNSL, effectively controlled tumor progression in patients, prolonged survival time and improved prognosis. Age was an independent prognostic factor in patients with PCNSL. Patients with an age of ≤60 years exhibited longer PFS compared with patients with an age of >60 years.

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Is There a Role for Radiotherapy in the Primary Management of Primary Central Nervous System Lymphoma? A Single-centre Case Series

Cited by 7 publications

References 25 publications

Response-adapted treatment with upfront high-dose chemotherapy followed by autologous stem-cell transplantation rescue or consolidation phase high-dose methotrexate for primary central nervous system lymphoma: a long-term mono-center study

Response-adapted treatment with upfront high-dose chemotherapy followed by autologous stem-cell transplantation rescue or consolidation phase high-dose methotrexate for primary central nervous system lymphoma: a long-term mono-center study

Could Cerebral Inflammatory Lesions be the Cellular Origin of Primary Central Nervous System Lymphoma?

Curative effect of methotrexate combined with teniposide in the treatment of primary central nervous system lymphoma

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