Long-term survival in primary CNS lymphoma.

Abstract

Combined modality therapy for PCNSL has improved survival, but relapse is common and late neurologic toxicity is a significant complication. Although this approach is highly effective for younger patients, efficacious but less neurotoxic regimens need to be developed for older patients.

Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study

“…9,10 In long-term survivors of brain metastases from systemic cancer, and in patients with primary lymphoma of the central nervous system, treatment with whole-brain radiotherapy can lead to radiation-induced encephalopathy. 11,12 Partly because of these side-effects, standard treatment of glioma patients is based on focal radiotherapy rather than on whole-brain radiotherapy. Apart from a large radiotherapy treatment volume, high radiotherapy total and fraction dose, concomitant chemotherapy, and old age have been identified as potential risk factors for cognitive deterioration in glioma Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study acknowledgments section).…”

Increasing incidence and continued dismal outcome of primary central nervous system lymphoma in Norway 1989–2003

“…However, like in many other studies, good performance status and young age had a favorable impact on survival 13,24,[39][40][41][42] ; patients who received only symptomatic therapy had shorter survival [18][19][20] and combined chemotherapy and radiotherapy was superior to chemotherapy alone 43 and radiotherapy alone. 44 We observed an estimated median survival of 44 months with combined chemotherapy and radiotherapy compared with a median survival of 9 months with radiotherapy alone and 4 months with chemotherapy alone, which led to fatal complications in 5 of 20 patients (25%).…”

“…Although it was not significant in our material, the omission of HD MTX in the chemotherapy regimen tended to reduce survival (hazard ratio, 1.50; 95% CI, 0.76-2.96; P 5 .24), which is in accordance with studies that reported a significant impact of HD MTX with hazard ratios of 2.3 29 and 1.48. 44 Despite the therapeutic advances reported from clinical trials the last decades, 17,20 the overall survival of patients who were diagnosed with PCNSL while they remained alive over the 3 5-year periods did not improve over time. This is in accordance with 2 population-based studies from the United States (1975-1999) 14 and Canada (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003), 29 which reported stable outcomes in the periods studied.…”

“…13,[17][18][19] The disadvantage of combined-modality therapy is the high risk of late neurotoxicity, which affects from 26% to 58% of patients and especially affects those aged >60 years. [19][20][21][22] Surgical resection yields no survival benefit and may increase functional deficits. 23,24 PCNSL may be difficult to diagnose.…”

Primary central nervous system lymphoma: what a neurologist/neurosurgeon should know?

“…However, a high incidence of neurotoxicity has been reported in patients receiving radiotherapy, mostly in patients older than 65 years. Up to 35% of patient will present with neurologic deterioration after radiotherapy, leading to a mortality rate of 30% in 5 years 26 . A recent progress is the establishment of a panel of neuropsychological tests to assess, quantify and follow-up treatment-related neurologic deterioration in patients with primary CNS lymphoma.…”