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From the Departments of Radiochemotherapy (Dr. Ferreri) and Pathology (Dr. Ponzoni), San Raffaele H. Scientific Institute, Milan; Divisione di Radioterapia (Dr. Reni), Ospedale di Circolo Fondazione Macchi, Varese; Divisione Clinicizzata di Oncologia Medica (Dr. Pasini), Ospedale Civile Maggiore, and Servizio Autonomo di Anatomia Patologica (Dr. Iuzzolino), Ospedale Civile Maggiore Az. Ospedaliera, Verona; Divisione di Oncologia Medica "A" (Dr. Tirelli) and Divisione di Anatomia Patologica (Dr. Carbone), Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano; Azienda Ospedaliera di Lecco (Dr. Aondio), Divisione di Radioterapia (Dr. Ferrarese), Ospedale Regionale di Treviso, and Servizio di Anatomia Patologica e Citologia (Dr. Motta) and Divisione di Ematologia (Dr. Barbui), Ospedali Riuniti di Bergamo, Italy; Institut für Medizinische Onkologie Inselspital (Dr. Calderoni) and Pathologisches Institut der Universität Bern (Dr. Weis), Istituto Cantonale di Patologia (Dr. Pedrinis), Locarno; Division de Pathologie Clinique CMU (Dr. Borisch), Hôpitaux Universitaires de Genève, Hôpital Cantonal, Genève, and Istituto Oncologico della Svizzera Italiana (Dr. Cavalli), Ospedale San Giovanni, Bellinzona, Switzerland; Hematology and Intensive Care Department (Dr. Pivnik), Hematological Center of Russian Academy of Medical Sciences, Moscow, Russia; Departamento de Medicina, Instituto de Enfermedades Neoplásicas (Dr. Gomez), Lima, Peru; and Service de Pathologie (Dr. Berger), Centre Hospitalier Lyon-Sud, Pierre Bénite, and Service de Pathologie (Dr. Chassagne), Centre Léon Bérard, Hôpital Neurologique (Dr. Jouvet), and Unité Cytokines et Cancers (Dr. Blay), Hôpital E. Herriot and Centre Léon Bérard, Lyon, France.
Address correspondence and reprint requests to Dr. Andrés J.M. Ferreri, Department of Radiochemotherapy, San Raffaele H. Scientific Institute, via Olgettina 60, 20132 Milan, Italy; e-mail: andres.ferreri{at}hsr.it
Objective: To characterize the therapeutic variables correlated to outcome in 370 patients with primary CNS lymphoma.
Methods: Planned treatment was radiotherapy (RT) in 98 patients, chemotherapy (CHT) in 32, RT followed by CHT in 36, and CHT followed by RT in 197 patients. High-dose methotrexate (HD-MTX; 1 to 8 g/m2) was used in 169 patients and intrathecal CHT in 109.
Results: One hundred sixteen patients are alive (median follow-up 24 months), with a 2-year overall survival of 37%. Patients treated with CHT followed by RT had improved survival with respect to patients treated with RT alone. Patients receiving HD-MTX–based primary CHT survived longer than those treated with other drugs. HD-MTX associated with other cytostatics, in particular HD-cytarabine, produced better results than HD-MTX alone. No correlation between MTX dose and survival was found. In patients receiving HD-MTX, consolidation RT or intrathecal CHT did not improve survival. Age, performance status, lactate dehydrogenase serum level, CSF protein level, site of disease, and use of HD-MTX were all predictors of survival.
Conclusions: Combination CHT-RT is superior to RT alone. Patients treated with primary CHT containing HD-MTX exhibited improved survival. In these patients, the addition of HD-cytarabine was associated with a better survival, whereas intrathecal CHT was not correlated to outcome. RT may be unnecessary in patients achieving complete remission after receiving HD-MTX–based primary CHT.
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