This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoang-Xuan, K. Articles by Baron, B. Search for Related Content PubMed PubMed Citation Articles by Hoang-Xuan, K. Articles by Baron, B. Related Articles Related Correspondence Related Reply Social Bookmarking                            What's this?

Chemotherapy Alone as Initial Treatment for Primary CNS Lymphoma in Patients Older Than 60 Years: A Multicenter Phase II Study (26952) of the European Organization for Research and Treatment of Cancer Brain Tumor Group

K. Hoang-Xuan, L. Taillandier, O. Chinot, P. Soubeyran, U. Bogdhan, J. Hildebrand, M. Frenay, N. De Beule, J.Y. Delattre, B. Baron

From the Fédération Neurologique Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neurologie, CHU Nancy; Service de Neurochirurgie, CHU La Timone, Marseille; Institut Bergonié, Bordeaux; Centre Antoine Lacassagne, Nice, France; Department of Neurology, Universität Klinik Regensburg, Germany; Service de Neurologie, Hôpital Erasme; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.

Address reprint requests to: K. Hoang-Xuan, MD, Fédération Neurologique Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’hôpital, 75651 Paris Cedex 13, France; email: khe.hoang-xuan{at}psl.ap-hop-paris.fr.

Purpose: To assess the efficacy and toxicity of chemotherapy alone in patients older than 60 years with primary CNS lymphoma.

Patients and Methods: Fifty patients with a median age of 72 years and a median Karnofsky performance score (KPS) of 50 were eligible for this multicenter phase II study. The protocol consisted of high-dose methotrexate (MTX), lomustine, procarbazine, methylprednisolone, and intrathecal chemotherapy with MTX and cytarabine. The patients received one induction cycle; if objective response was achieved, five additional maintenance cycles were administered every 6 weeks. The median follow-up of patients was 3 years.

Results: Twenty four patients (48%) achieved an objective response (compete response [CR], 42%; partial response, 6%), with a median duration of CR of 27 months (range, 3 to 47+ months). Overall median survival time was 14.3 months, and 1-year progression-free survival was 40% (95% confidence interval [CI], 26% to 53%). Myelosuppression was the most frequent side effect, with grade 3 to 4 neutropenia in 19% of patients. One patient died during chemotherapy, as a result of pulmonary embolism. Most patients improved or preserved their cognitive functions (47% and 45% of the patients, respectively) and KPS (36% and 52% of the patients, respectively) until relapse, whereas cognitive and KPS decline attributed to delayed treatment neurotoxicity occurred in 8% and 12% patients, respectively.

Conclusion: In the elderly, this chemotherapy regimen compares favorably with radiotherapy (RT) alone and reduces considerably the risk of delayed neurotoxicity associated with combined chemoradiotherapy. Chemotherapy alone is an appropriate strategy in older patients to delay or avoid RT.

Presented in part at the Fourth Meeting of the European Association of Neuro-Oncology (EANO), Copenhagen, Denmark, June 3–6, 2000.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Is Withdrawal of Consolidation Radiotherapy an Evidence-Based Strategy in Primary Central Nervous System Lymphomas?
  Michele Reni and Andrés J.M. Ferreri
  JCO 2004 22: 1165-1167 [Full Text]

Related Reply

• In Reply:
  K. Hoang-Xuan and J.Y. Delattre
  JCO 2004 22: 1167-1168 [Full Text]

This article has been cited by other articles:

				H. Ghesquieres, C. Ferlay, C. Sebban, D. Perol, A. Bosly, O. Casasnovas, O. Reman, B. Coiffier, H. Tilly, P. Morel, et al. Long-term follow-up of an age-adapted C5R protocol followed by radiotherapy in 99 newly diagnosed primary CNS lymphomas: a prospective multicentric phase II study of the Groupe d'Etude des Lymphomes de l'Adulte (GELA) Ann. Onc., November 18, 2009; (2009) mdp529v2. [Abstract] [Full Text] [PDF]

				L. Angelov, N. D. Doolittle, D. F. Kraemer, T. Siegal, G. H. Barnett, D. M. Peereboom, G. Stevens, J. McGregor, K. Jahnke, C. A. Lacy, et al. Blood-Brain Barrier Disruption and Intra-Arterial Methotrexate-Based Therapy for Newly Diagnosed Primary CNS Lymphoma: A Multi-Institutional Experience J. Clin. Oncol., July 20, 2009; 27(21): 3503 - 3509. [Abstract] [Full Text] [PDF]

				M. Sierra del Rio, A. Rousseau, C. Soussain, D. Ricard, and K. Hoang-Xuan Primary CNS Lymphoma in Immunocompetent Patients Oncologist, May 1, 2009; 14(5): 526 - 539. [Abstract] [Full Text] [PDF]

				U. Schlegel Review: Primary CNS lymphoma Therapeutic Advances in Neurological Disorders, March 1, 2009; 2(2): 93 - 104. [Abstract] [PDF]

				G. Illerhaus, R. Marks, F. Muller, G. Ihorst, F. Feuerhake, M. Deckert, C. Ostertag, and J. Finke High-dose methotrexate combined with procarbazine and CCNU for primary CNS lymphoma in the elderly: results of a prospective pilot and phase II study Ann. Onc., February 1, 2009; 20(2): 319 - 325. [Abstract] [Full Text] [PDF]

				J.-J. Zhu, E. R. Gerstner, D. A. Engler, M. M. Mrugala, W. Nugent, K. Nierenberg, F. H. Hochberg, R. A. Betensky, and T. T. Batchelor High-dose methotrexate for elderly patients with primary CNS lymphoma Neuro-oncol, January 1, 2009; 11(2): 211 - 215. [Abstract] [Full Text] [PDF]

				S. Schwartz, K. Borner, K. Muller, P. Martus, L. Fischer, A. Korfel, T. Auton, and E. Thiel Glucarpidase (Carboxypeptidase G2) Intervention in Adult and Elderly Cancer Patients with Renal Dysfunction and Delayed Methotrexate Elimination After High-Dose Methotrexate Therapy Oncologist, November 1, 2007; 12(11): 1299 - 1308. [Abstract] [Full Text] [PDF]

				B. C. Widemann and P. C. Adamson Understanding and managing methotrexate nephrotoxicity. Oncologist, June 1, 2006; 11(6): 694 - 703. [Abstract] [Full Text] [PDF]

				C. S. Ha, L. J. Medeiros, C. Charnsangavej, M. Crump, and M. K. Gospodarowicz Oncodiagnosis Panel: 2004: Lymphoma RadioGraphics, March 1, 2006; 26(2): 607 - 620. [Full Text] [PDF]

				L. M. DeAngelis and F. M. Iwamoto An Update on Therapy of Primary Central Nervous System Lymphoma Hematology, January 1, 2006; 2006(1): 311 - 316. [Abstract] [Full Text] [PDF]

				A. M. P. Omuro, L. S. Ben-Porat, K. S. Panageas, A. K. Kim, D. D. Correa, J. Yahalom, L. M. DeAngelis, and L. E. Abrey Delayed Neurotoxicity in Primary Central Nervous System Lymphoma Arch Neurol, October 1, 2005; 62(10): 1595 - 1600. [Abstract] [Full Text] [PDF]

				L. E. Abrey, T. T. Batchelor, A. J.M. Ferreri, M. Gospodarowicz, E. J. Pulczynski, E. Zucca, J. R. Smith, A. Korfel, C. Soussain, L. M. DeAngelis, et al. Report of an International Workshop to Standardize Baseline Evaluation and Response Criteria for Primary CNS Lymphoma J. Clin. Oncol., August 1, 2005; 23(22): 5034 - 5043. [Abstract] [Full Text] [PDF]

				E. T. Wong, L. E. Abrey, R. H. Enting, A. Demopoulos, and L. M. DeAngelis Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide Neurology, March 8, 2005; 64(5): 934 - 934. [Full Text] [PDF]

				A. M.P. Omuro, L. M. DeAngelis, J. Yahalom, and L. E. Abrey Chemoradiotherapy for primary CNS lymphoma: An intent-to-treat analysis with complete follow-up Neurology, January 11, 2005; 64(1): 69 - 74. [Abstract] [Full Text] [PDF]

				K. Hoang-Xuan and J.Y. Delattre In Reply: J. Clin. Oncol., March 15, 2004; 22(6): 1167 - 1168. [Full Text] [PDF]

				M. Reni and A. J.M. Ferreri Is Withdrawal of Consolidation Radiotherapy an Evidence-Based Strategy in Primary Central Nervous System Lymphomas? J. Clin. Oncol., March 15, 2004; 22(6): 1165 - 1167. [Full Text] [PDF]