Treatment > Methotrexate  

Meeting Abstract

Any role for brain irradiation in the treatment of primary central nervous system lymphoma (PCNSL)?

Jacob Baram, Yonathan Goldhammer, Zvi Ram, Thomas Tichler, Dvora Nass, Raffael Catane, Raffael Pfeffer, Ilan Blatt

Sheba Medical Center, Tel Hashomer, Israel

High dose methotrexate (MTX) and brain irradiation are recommended treatments for PCNSL although the combination of these modalities results in a substantial risk of neurotoxicity.
Our standard treatment during the period 1990-1998 included administration of MTX at a dose of 3.5 g/m2 every 10 days for 6 cycles followed by brain radiotherapy for 40 Gy.
However for most patients who obtained CR with MTX we elected to use maintenance MTX instead of XRT.
We treated 32 patients, 21 females and 11 males.
4 patients were lost to follow up.
The median age was 62 years, range 20-72 years.
10 patients (36%) achieved CR, 6 (21%) PR, 4 (14%) SD and 8 (29%) PD following the chemotherapy.
The median survival of all patients was 34 mo.
Two poor prognostic factors were age above 65 years ( p=0.01 ) and KPS below 50%( p=0.13 ).
All patients, excluding 6 out of 10 patients with CR were treated with irradiation after completion of chemotherapy.
These 6 CR patients were treated with maintenance high dose MTX (at 1-3 months intervals ) and did not receive brain irradiation.
The median survival of these 6 patients is above 7.4 years.
Two of them relapsed after 16 and 73 months and received XRT, but 4 are alive and well at 6 – 11 years.
We suggest that although the CR with HDMTX rate is moderate, maintenance treatment with this drug might prevent brain irradiation.

© Copyright 2002 American Society of Clinical Oncology