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KMID : 0942820100090020074
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Journal of Korean Brain Tumor Society
2010 Volume.9 No. 2 p.74 ~ p.79
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Clinical Experience of Primary CNS Lymphoma
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Choi Hyung-Yong
Cho Kyung-Gi
Kim Se-Hyuk
Ahn Young-Hwan
Lee Sang-Yul
Kim Hugh-Chul
Lee Hyun-Woo
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Abstract
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Objective: Treatment of choice for primary central nervous system(CNS) lymphoma is radiotherapy and chemotherapy using high-dose methotrexate(HD-MTX), although its hepatotoxicity and nephrotoxicity refrains it from wide use among the old age and patients with decreased kidney and liver function. HD-MTX is under clinical study for its safe and effective usage. We hereby discuss treatment plans for primary CNS lymphoma based on cases from our institute.
Methods: Total 20 cases of primary CNS lymphoma patients were experimented from year 1998 to 2008. Of the cases 8 were males and 12 females, with mean age of 57.2(Age 35-75). With exception of 4 patients who refused treatment, 16 patients received either radiotherapy or chemotherapy. Four patients underwent radiotherapy only, 4 patients chemotherapy only with 2 via CHOP regimen and the rest 2 via HD-MTX regimen, and 8 patients received concurrent chemotherapy and radiotherapy. Four of the concurrent chemotherapy and radiotherapy patients used temozolomide(TMZ) as well.
Results: The patients’ overall survival period was 13.9 months average with exception of 4 patients who was lost during follow-up. Mean survival for patients who received only radiotherapy was 11.6 months, those with only chemotherapy was 2.5 months, and those with concurrent chemotherapy and radiotherapy was 22.2 months. Those who received chemotherapy and radiotherapy and TMZ as well had mean survival period of 28.2 months, longer than the other groups.
Conclusion: Most primary CNS lymphoma patients die within 1 year of occurrence. But consideration must be put into the fact that about 50% of these patients are over 60 years old, and previously widely used chemotherapy agent may have been too toxic. Even though HD-MTX chemotherapy seems to be the best approach to achieve effective tumor control, the dose reduction for Korean patients should be needed to reduce toxic complication. On the other hand, TMZ was less toxicity and effective for the primary CNS and Non-Hodgkin’s lymphoma on the base of our series. We may conclude that TMZ might be safe and effective alternative chemotherapeutic agent, especially for the elderly or recurrent patients.
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KEYWORD
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Central nervous system(CNS), Lymphoma, Temozolomide
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