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KMID : 0942820110100020072
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Journal of Korean Brain Tumor Society
2011 Volume.10 No. 2 p.72 ~ p.77
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Effectiveness and Limitation of Gamma Knife Surgery for Relapsed Central Nervous System Lymphoma
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Lee Su-Heon
Cha Seung-Heon
Hur Beong-Ik
Kang Dong-Wan
Cho Won-Ho
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Abstract
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Introduction Although there has been no established treatment protocol for central nervous system lymphoma (CNSL), high dose methotrexatae therapy with or without external beam radiotherapy (EBRT) is generally adopted as a standard therapeutic regimen. However, recurrence of CNSL following standard treatment is often observed, even within the previously irradiated field. Therefore, we thought that Gamma knife surgery (GKS) can be an excellent alternative measure for recurrent CNSL after initial treatment. The purpose of this study was to investigate the effectiveness of GKS for the CNSL as a palliative treatment modality.
Materials and Methods: We retrospectively reviewed 21 recurrent CNSL lesions in 5 patients underwent GKS Between January 2007 and December 2010. There were two male and three female patients and their age was 41-72 years (median 52.2) old at the time of the first GKS. All patients were confirmed as diffuse large B-cell lymphoma through the pathologic diagnosis. Three patients had primary CNSL, and the remaining two patients had CNS involvement of systemic lymphoma. All patients had a history of previous chemotherapy and/or radiotherapy.
Results: All patients were treated without severe adverse effects. The target volume was 0.1-38.4 mL (median 5.2). The marginal dose was 12-20 Gy (median 18.7) to the 50% isodose line. Follow up MR images revealed complete response (CR) and partial response (PR) in 95% cases. The neurologic symptoms disappeared or improved rapidly in all patients. However all of the patients showed recurrent CNSL 1 to 10 months (mean : 4 month) after GKS. Median overall survival time and median intracranial relapse-free survival time was 9.1 months and 4.6 months, respectively.
Conclusion: GKS might be used as a safe and excellent treatment modality in the patients with recurrent CNSL. Moreover, GKS provides the rapid clinical improvement within the short interval from the treatment. However, despite its rapid palliative effect, short-term effectiveness period limited its usefulness. Therefore, adjuvant chemotherapy is essential following GKS in the CNSL.
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KEYWORD
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Central nervous system neoplasms , Lymphoma , Gamma knife radiosurgery
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