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Low-dose whole brain radiotherapy combined with radiosurgery for primary CNS lymphoma achieving partial response to induction methotrexate-based chemotherapy.

Publication ,  Journal Article
Oh, DS; Vredenburgh, JA; Reardon, DA; Prosnitz, LR; Gockerman, JP; Sampson, JH; Kelsey, CR; Kirkpatrick, JP
Published in: J Radiosurg SBRT
2014

PURPOSE: For patients with primary CNS lymphoma who achieve complete response (CR) after induction methotrexate-based chemotherapy with rituximab, low-dose whole brain radiation therapy (LD-WBRT) appears effective and is well tolerated. For patients who respond to induction methotrexate-based chemotherapy with or without rituximab but have unifocal residual disease less than 3 cm in size, we hypothesized that LD-WBRT combined with radiosurgery would be effective at controlling residual disease and well tolerated. METHODS: Four adult patients with primary CNS lymphoma with a favorable response to induction chemotherapy but had residual disease less than 3 cm were identified. Induction chemotherapy consisted of methotrexate with or without additional agents including rituximab. LD-WBRT comprised 2340 cGy in 13 fractions. This was immediately preceded or followed by a single radiosurgery treatment of 12 12.5 Gy to the focus of residual disease defined on contrast enhanced T1 weighted MRI. RESULTS: The median follow-up was 17.1 months (range 10-23 months). All patients had residual disease after induction chemotherapy but achieved complete response (CR) following LD-WBRT and radiosurgery. Three patients remained free of disease. One patient developed distant brain recurrence 12 months after radiation but remained alive at last follow-up (17 months). No treatment-related neurotoxicity was observed. CONCLUSIONS: The combination of induction methotrexate-based chemotherapy with or without rituximab, LD-WBRT and radiosurgery appears effective and well tolerated in patients with primary CNS lymphoma who achieve a partial response (PR) to chemotherapy with minimal residual disease. Longer follow-up and larger patient numbers are clearly needed for confirmation.

Duke Scholars

Published In

J Radiosurg SBRT

ISSN

2156-4639

Publication Date

2014

Volume

3

Issue

1

Start / End Page

37 / 42

Location

United States
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Oh, D. S., Vredenburgh, J. A., Reardon, D. A., Prosnitz, L. R., Gockerman, J. P., Sampson, J. H., … Kirkpatrick, J. P. (2014). Low-dose whole brain radiotherapy combined with radiosurgery for primary CNS lymphoma achieving partial response to induction methotrexate-based chemotherapy. J Radiosurg SBRT, 3(1), 37–42.
Oh, Daniel S., James A. Vredenburgh, David A. Reardon, Leonard R. Prosnitz, Jon P. Gockerman, John H. Sampson, Christopher R. Kelsey, and John P. Kirkpatrick. “Low-dose whole brain radiotherapy combined with radiosurgery for primary CNS lymphoma achieving partial response to induction methotrexate-based chemotherapy.J Radiosurg SBRT 3, no. 1 (2014): 37–42.
Oh DS, Vredenburgh JA, Reardon DA, Prosnitz LR, Gockerman JP, Sampson JH, et al. Low-dose whole brain radiotherapy combined with radiosurgery for primary CNS lymphoma achieving partial response to induction methotrexate-based chemotherapy. J Radiosurg SBRT. 2014;3(1):37–42.
Oh DS, Vredenburgh JA, Reardon DA, Prosnitz LR, Gockerman JP, Sampson JH, Kelsey CR, Kirkpatrick JP. Low-dose whole brain radiotherapy combined with radiosurgery for primary CNS lymphoma achieving partial response to induction methotrexate-based chemotherapy. J Radiosurg SBRT. 2014;3(1):37–42.

Published In

J Radiosurg SBRT

ISSN

2156-4639

Publication Date

2014

Volume

3

Issue

1

Start / End Page

37 / 42

Location

United States