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Multi-modality Therapy Leads to Longer Survival in Primary Central Nervous System Lymphoma Patients

Published online by Cambridge University Press:  14 September 2018

Dhruv Singhal
Affiliation:
Departments of Neurological Surgery and Radiation Oncology and the Center For Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Timothy F. Witham
Affiliation:
Departments of Neurological Surgery and Radiation Oncology and the Center For Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Anand Germanwala
Affiliation:
Departments of Neurological Surgery and Radiation Oncology and the Center For Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
John C. Flickinger
Affiliation:
Departments of Neurological Surgery and Radiation Oncology and the Center For Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
David Schiff
Affiliation:
Departments of Neurological Surgery and Radiation Oncology and the Center For Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Douglas Kondziolka
Affiliation:
Departments of Neurological Surgery and Radiation Oncology and the Center For Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract:

Background:

Primary central nervous system lymphoma (PCL) is more frequently encountered by neurosurgeons given the increasing incidence among both nonimmunocompromised and immunocompromised patients. The most frequent surgery is stereotactic biopsy. Historically, radiation therapy has been the standard treatment modality for this disease and median survival was in the 15-month range. More recently, multi-modality therapy combining radiation therapy with chemotherapy (systemic, intrathecal, and/or intra-arterial) have resulted in longer survivals. We reviewed survival data for our series of patients treated for PCL over the last decade.

Methods:

Thirty-four patients with histologically confirmed PCL were treated at our center. Multivariate Cox regression analysis was performed to determine which factor(s) (age, gender, HIV status, Karnofsky Performance Scale, chemotherapy, single modality therapy, histology, location, number of lesions, surgical resection) had a significant impact on survival.

Results:

The overall median survival was 19 months. Patients receiving multi-modality therapy (n=17) (chemotherapy and radiation) had a median survival of 34 months compared to four months for patients receiving single modality therapy (n=17 including seven HIV positive patients). Multi-modality therapy was the only significant factor affecting survival in this multivariate analysis (p<0.0001).

Conclusions:

Chemotherapy plus radiotherapy significantly enhances survival over patients treated with single modality therapy alone. Quality of life issues should be addressed on a case by case basis as additional treatment modalities are initiated.

Résumé:

Résumé: Introduction:

Le lymphome primitif du SNC est plus fréquemment rencontré par les neurochirurgiens à cause de son incidence croissante tant parmi les patients non immunocompromis que les patients immunocompromis. La chirurgie la plus courante est la biopsie stéréotaxique. Historiquement, la radiothérapie était le traitement standard de cette maladie et la survie médiane était de l’ordre de 15 mois. Récemment, la thérapie multimodale combinant la radiothérapie et la chimiothérapie (systémique, intrathécale et/ou intra-artérielle) a prolongé la survie. Nous revoyons les données sur la survie dans notre série de patients traités pour lymphome primitif du SNC pendant la dernière décennie.

Méthodes:

Trente-quatre patients porteurs d’un lymphome primitif du SNC confirmé en anatomopathologie ont été traités dans notre centre. L’analyse de régression multivariée de Cox a été utilisée pour déterminer quel(s) facteur(s) (l’âge, le genre, le statut VIH, le score à l’échelle de performance de Karnofsky (KPS), la chimiothérapie, la thérapie unimodale (XRT), l’histologie, le site, le nombre de lésions, la résection chirurgicale) avait (avaient) un impact significatif sur la survie.

Résultats:

La survie médiane était de 19 mois. Les patients ayant reçu la thérapie multimodale (n=17) (chimiothérapie et radiothérapie) avaient une survie médiane de 34 mois versus quatre mois pour les patients recevant XRT (n=17, incluant sept patients VIH positifs). La thérapie multimodale était le seul facteur significatif affectant la survie dans cette analyse multivariée (p<0,0001).

Conclusions :

La chimiothérapie associée à la radiothérapie augmente significativement la survie par rapport à la XRT seule. Les questions relatives à la qualité de vie devraient être considérées cas par cas lorsque des modalités de traitement additionnelles sont entreprises.

Type
Original Article
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

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