Prognosis of primary central nervous system lymphoma treated with radiotherapy alone
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ORIGINAL ARTICLE
Prognosis of primary central nervous system lymphoma treated with radiotherapy alone Senzo Taguchi • Yasushi Hamamoto • Takashi Fujii • Takashi Ochi • Hironobu Harada Takanori Ohnishi • Teruhito Mochizuki
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Received: 8 May 2012 / Accepted: 15 August 2012 / Published online: 11 September 2012 Ó Japan Radiological Society 2012
Abstract Purpose Standard treatment for patients with primary central nervous system (CNS) lymphoma involves combining high-dose methotrexate-based chemotherapy and radiation. However, chemotherapy is sometimes contraindicated, and radiotherapy alone becomes the only option. We retrospectively investigated the clinical outcomes of primary CNS lymphoma patients treated with radiotherapy alone. Materials and methods Between 1983 and 2006, 35 patients (median age 69 years, range 37–89 years) with primary CNS lymphoma were treated with radiotherapy alone. Of these, 74 % had an Eastern Cooperative Oncology Group performance status (PS) of 2–4. Most patients (91 %) received whole-brain irradiation with or without irradiation boost to the tumor site (median dose 50 Gy, range 22–50 Gy); remaining patients received partial brain irradiation. Results Median follow-up time was 20 (range 1–152) months, median survival time was 20 months, and the 1- and 2-year overall survival rates were 65 and 32 %,
S. Taguchi (&) Y. Hamamoto T. Mochizuki Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan e-mail: [email protected] T. Fujii Department of Radiology, Tenri Hospital, Tenri, Japan T. Ochi Department of Radiology, Shikoku Cancer Center, Matsuyama, Japan H. Harada T. Ohnishi Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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respectively. Median survival in patients aged \70 and C70 years was 26 and 10 months, respectively (p = 0.01). Conclusion Median survival with radiotherapy alone was 20 months. Patients aged \70 years have a better prognosis than those C70 years. Keywords Elderly Primary CNS lymphoma Prognostic factor Radiotherapy alone
Introduction Primary central nervous system (CNS) lymphoma is an aggressive lymphoma that appears to be distinct from other types of diffuse large B-cell lymphoma. It accounts for approximately 4 % of primary brain tumors and is confined to the CNS, rarely with metastases occurring outside the CNS [1]. Primary CNS lymphoma is comparatively rare, and its prognosis is poor even after intensive curative treatment and is certainly unsatisfactory compared with that of malignant lymphoma at other primary sites [2]. Nasal natural-killer (NK) T-cell lymphoma, however, has a worse prognosis than does primary CNS lymphoma [3, 4]. Median survival after radiotherapy alone is poor, but it is significantly improved when combined with high-dose methotrexate (MTX)-based chemotherapy. This combination therapy results in long-term remission and improved survival rates [5]. At present, high-dose MTX-based chemotherapy followed by whole-brain irradia
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