Cancer Res Treat.  2014 Jul;46(3):261-269.

Low-Dose Whole Brain Radiotherapy with Tumor Bed Boost after Methotrexate-Based Chemotherapy for Primary Central Nervous System Lymphoma

• Kim BH
• Kim IH
• Park SH
• Park CK
• Jung HW
• Kim TM
• Lee SH
• Heo DS

Abstract

PURPOSE
The purpose of this study is to evaluate the outcome of low-dose whole brain radiotherapy (WBRT) with tumor bed boost after methotrexate-based chemotherapy in the management of primary central nervous system lymphoma (PCNSL).
MATERIALS AND METHODS
We retrospectively analyzed 64 patients with pathologically proven PCNSL between 2000 and 2011. Methotrexate-based chemotherapy with a median of five cycles was followed by radiotherapy to the whole brain and to the initial tumor bed. The median dose to the whole brain and to the tumor bed was 27 Gy (range, 18 to 36 Gy) and 50.4 Gy (range, 45 to 54 Gy), respectively.
RESULTS
With a median follow-up period of 27 months, 55 patients (85.9%) achieved complete response (CR). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.6% and 39.3%, respectively. In univariate analysis, factors associated with OS were age, performance status, involvement of deep structure, and CR to sequential chemoradiotherapy (CRT). These variables remained as significant factors for OS in multivariate analysis. CR to sequential CRT was the only positive factor associated with PFS (p=0.009). Neurologic toxicity was more common in elderly patients older than 60 years (p=0.025).
CONCLUSION
Low-dose WBRT with tumor bed boost after methotrexate-based chemotherapy might be an effective method for management of PCNSL.

Keyword

Radiotherapy; Methotrexate; Central nervous system; Lymphoma

MeSH Terms

Aged
Brain*
Central Nervous System*
Chemoradiotherapy
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Lymphoma*
Methotrexate
Multivariate Analysis
Radiotherapy*
Retrospective Studies
Methotrexate

Figure

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  Fig. 1. Kaplan-Meier curve for overall survival.

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  Fig. 2. Kaplan-Meier curve for progression-free survival.

Reference

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