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Long-Term Follow-Up of High-Dose
Methotrexate-Based Therapy With and Without Whole Brain Irradiation
for Newly Diagnosed Primary CNS Lymphoma
Igor T. Gavrilovic,
Adília Hormigo, Joachim Yahalom, Lisa
M. DeAngelis, Lauren E. Abrey
From the Departments of Neurology
and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New
York, NY -- Address reprint requests to Lauren E. Abrey, MD,
Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275
York Ave, New York, NY 10021; e-mail: abreyl@mskcc.org
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Purpose. We previously
reported a series of patients treated with high-dose methotrexate
(MTX) -based chemotherapy, with or without whole brain
radiotherapy.
The purpose of this report is to update
the initial results and provide long-term data regarding overall
survival, patterns of relapse, and the risk of treatment-related
neurotoxicity.
Patients and Methods.
Fifty-seven patients with an average age of 65 and median Karnofsky
performance score of 70 were treated; all patients have been
observed longitudinally with serial magnetic resonance imaging
scans and neurologic examinations.
Results. The overall
median survival was 51 months with a median follow-up of
115 months for surviving patients.
Twenty-five patients relapsed or
developed progressive disease; median progression-free survival was
129 months.
Seventeen patients developed
treatment-related neurotoxicity; all but one had received
whole brain radiotherapy as a component of treatment.
Seventy-four percent of patients younger
than 60 years who received both MTX-based chemotherapy and
whole brain radiotherapy were alive at last follow-up.
Median survival for patients
older than 60 years was 29 months regardless of whether or
not they received whole brain radiotherapy.
Conclusion. Long-term
follow-up of our initial cohort confirms the observation of
excellent overall survival, particularly for those patients younger
than age 60 at diagnosis.
For older patients, it appears to
be reasonable to defer whole brain radiotherapy in an effort to
minimize treatment-related neurotoxicity.
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