Preirradiation chemotherapy with cyclophosphamide, doxorubicin, vincristine, and dexamethasone for primary CNS lymphomas: initial report of radiation therapy oncology group protocol 88-06.

Abstract

Preirradiation CHOD chemotherapy does not significantly improve survival over RT alone for patients with PCNSL. Age remains a powerful prognostic factor independent of therapy and must be considered in testing alternative combined approaches.

High-dose thiotepa, busulfan, cyclophosphamide and ASCT without whole-brain radiotherapy for poor prognosis primary CNS lymphoma

“…This observation suggests that HDCT for PCNSL should include drugs that penetrate the CNS extremely well rather than standard regimens used to treat systemic lymphoma such as BEAM, which do not penetrate well into the CNS. 4,9,12,27 This pilot study is also encouraging in that patients experienced an improvement in their neurological performance and QOL following the TBC/ASCT. This is consistent with previous studies that demonstrate HD-MTX-based chemotherapy alone without WBRT is associated with much less late onset neurotoxicity.…”

“…[4][5][6][7][8] Adding CHOP to RT does not improve outcome. 4,9 Although combined modality treatment (CMT) with high-dose methotrexate (HD-MTX)-based chemotherapy and WBRT results in higher disease-free and overall survival rates, it is associated with severe neurotoxicity. 5,10 Treatment-related neurotoxicity manifests as dementia, ataxia, incontinence, and may lead to death in patients who are otherwise 'cured' of their PCNSL.…”

Area under the curve of methotrexate and creatinine clearance are outcome-determining factors in primary CNS lymphomas

“…Nevertheless, as has been reported for other malignancies (Evans et al, 1986;Graf et al, 1994;Delepine et al, 1995;Bacci et al, 1998), the characterisation of the MTX variables investigated could be useful to identify different risk groups and to define the optimal administration schedule of this drug in PCNSL patients. HD-MTX is the most effective drug against PCNSL; any regimen without this drug is associated with outcomes which are no better than with RT alone (Schultz et al, 1996;O'Neill et al, 1999;Mead et al, 2000). When used as primary treatment, alone or combined Patients with a slow CL crea (p85 ml min À1 ; dotted line) showed a better OS with respect to patients with a fast CL crea (485 ml min À1 ; continued line).…”

“…(Reni et al, 1997;Ferreri et al, 2002b). Any chemotherapy regimen without HD-MTX is associated with outcomes no better than those obtained with radiotherapy (RT) alone in these malignancies (Schultz et al, 1996;O'Neill et al, 1999;Mead et al, 2000), while the survival benefit of the addition of other drugs to HD-MTX remains a matter of debate (Reni et al, 2001;Ferreri et al, 2002b). In spite of its central role in PCNSL treatment, the optimal dose, administration schedule, and dose timing of MTX have not been clearly defined.…”

Molecular pathology of primary intraocular lymphoma

“…75 However, recurrences are common following radiation therapy. Currently, chemotherapy is recommended as the first treatment for all patients with PCNSL.…”