Low-Dose Whole Brain Radiotherapy with Tumor Bed Boost after Methotrexate-Based Chemotherapy for Primary Central Nervous System Lymphoma
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PurposeThe 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 themanagement of primary central nervous system lymphoma (PCNSL). Materials and MethodsWe retrospectively analyzed 64 patients with pathologically proven PCNSL between2000 and 2011. Methotrexate-based chemotherapy with a median of five cycles wasfollowed by radiotherapy to the whole brain and to the initial tumor bed. The mediandose to the whole brain and to the tumor bed was 27 Gy (range, 18 to 36 Gy) and 50.4Gy (range, 45 to 54 Gy), respectively. ResultsWith a median follow-up period of 27 months, 55 patients (85.9%) achieved completeresponse (CR). The 5-year overall survival (OS) and progression-free survival (PFS)rates were 52.6% and 39.3%, respectively. In univariate analysis, factors associatedwith OS were age, performance status, involvement of deep structure, and CR tosequential chemoradiotherapy (CRT). These variables remained as significant factorsfor OS in multivariate analysis. CR to sequential CRT was the only positive factor associatedwith PFS (p=0.009). Neurologic toxicity was more common in elderly patientsolder than 60 years (p=0.025). ConclusionLow-dose WBRT with tumor bed boost after methotrexate-based chemotherapy mightbe an effective method for management of PCNSL.
Abstract
PurposeThe 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 themanagement of primary central nervous system lymphoma (PCNSL). Materials and MethodsWe retrospectively analyzed 64 patients with pathologically proven PCNSL between2000 and 2011. Methotrexate-based chemotherapy with a median of five cycles wasfollowed by radiotherapy to the whole brain and to the initial tumor bed. The mediandose to the whole brain and to the tumor bed was 27 Gy (range, 18 to 36 Gy) and 50.4Gy (range, 45 to 54 Gy), respectively. ResultsWith a median follow-up period of 27 months, 55 patients (85.9%) achieved completeresponse (CR). The 5-year overall survival (OS) and progression-free survival (PFS)rates were 52.6% and 39.3%, respectively. In univariate analysis, factors associatedwith OS were age, performance status, involvement of deep structure, and CR tosequential chemoradiotherapy (CRT). These variables remained as significant factorsfor OS in multivariate analysis. CR to sequential CRT was the only positive factor associatedwith PFS (p=0.009). Neurologic toxicity was more common in elderly patientsolder than 60 years (p=0.025). ConclusionLow-dose WBRT with tumor bed boost after methotrexate-based chemotherapy mightbe an effective method for management of PCNSL.
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