Tehran University Medical Journal (Sep 1999)
Treatment of primary brain lymphoma without immune deficiency, The importance of chemotherapy before radiotherapy
Abstract
The purpose of this study was to find a more efficacious treatment for patients with primary central nervous system Lymphoma using chemotherapy. The objective was to determine the optimal time for radiotherapy treatment in relation to chemotherapy. Retrospective evaluation in patients with brain lymphoma was conducted from 1992 to 1998. Twenty-three patients were evaluated. Patients were divided into two groups based on the timing of radiotherapy in relation to the chemotherapy. The first group of patients (n=13) initially received radiotherapy followed by chemotherapy. Five of these patients receied classic CHOP (cyclophosphamide), Doxorubicine, Vincistine and Prednisone), six patients received Cis-platin (60 Megs/M2) and Etoposide (120 Megs/M2) and two patients received Cis-platin (60 Megs/M2), Etoposide (120 Megs/M2) and Cytarabine (600 Megs/M2) every 2 to 3 weeks. The second group of patients (Group II, n=10) received the followeing treatment regimen: a course of BCNU 120 Megs/M2 with Ifosfamide 1200 Megs/M2, Mesna and Etoposide 120 Megs/M2 on the first day of treatment (course A). Two weeks later, treatment was continued with a course of Cis-platin 35 Megs/M2 and Cytarabine 600 Megs/M2 (course B). The treatment was continued 14 days later with a course of Mitoxantron 12 Megs/M2, Ifosfamide 1200 Megs/M2 puls Mesna (course C). After the fourth week of chemotherapy, these patients received radiotherapy to the brain (5000 RADS in 4 weeks). During radiotherapy and at the beginning of course chemotherapy, intrathecal therapy with Methorexate 12 Megs/M2 and Cytarabine 60 Megs/M2 was given. Immediately after radiotherapy, the same chemothotrexate 12 Megs/M2 and Cytarabine 60 Megs/M2 was given. Immediately after radiotherapy, the same chemotherapy treatment was repeated to a total of 3 times. After complete clearance of the tumor determined by MRI and absence of tumor cells in the spinal fluid, the chemotherapeutic regimen was repeated one last time. The patients were evaluated for disease free survival and relaps based on the different treatment groups. Results: Median follow-up time was 19 months. Ten patients relapsed. These patients initially received radiotherapy (Group I). In this time period there were no relapses in Group II patients. The median DFS was 24 months with a chance of survival in 3 years of 45.95+11.95% for both groups. Chemotherapy followed by radiotherapy was more efficacious than radiotherapy prior to chemotherapy. Two years survival was 9% in contrast to 100% in favor of chemotherapy followed by radiotherapy. Conclusion: The above model demonstrated that treatment using a protocol consisting of chemotherapy prior to radiation provides improved disease free survival over a treatment regimen consisting of radiotherapy followed by chemotherapy.
