Primary central nervous system non-hodgkin's lymphoma: Survival advantages with combined initial therapy?

Brian Patrick O'Neill, Judith R. O'Fallon, John D. Earle, Joseph P. Colgan, Loren D. Brown, Robert L. Krigel

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Purpose: Results of multiple radiation, chemotherapy, and combined treatment trials have shown that the fate of primary central nervous system lymphoma (PCNSL) patients is very different from that of patients with similarly treated systemic IE non-Hodgkin's lymphoma. This study was designed to improve the survival of PCNSL patients by the use of combined initial therapy. Methods and materials: Forty-six eligible primary PCNSL patients were treated with whole brain irradiation and adjuvant chemotherapy consisting of preirradiation cyclophosphamide-adriamycin-vincristine-prednisome (CHOP) and postirradiation high-dose cytosine arabinoside (HDAC) as part of an ongoing Phase II Mayo/North Central Cancer Treatmetn Group/Eastern Cooperative Oncology Group (M/NCCTG/ECOG) intergroup effort, which opened in April 1986. Results: This cohort consisted of 23 men and 23 women with median age 63.5 years (range 24 to 75 years). Only 5% were under age 40; 36% were age 40 to 59, 37% were age 60 to 69, and 22% were age 70 and over. Forty-six percent had good performance scores of ECOG 0-1 at time of study entry. Forty-six patients were evaluated for treatment outcome as of October 6, 1993. Of these, 10 were still alive. Estimated median survival and 21-month survival were 45.3 weeks and 29%, respectively. There were deaths ranging from Day 9 to Day 15 (three drug-related, one from other complications), and two CHOP responders died at 32 and 35 days, soon after Cycle 2 of CHOP (one probably drug-related, one from other complications). There was no significant difference in survival according to baseline performance status. However, survival was consistently worse for patients > 60 years old than for the younger patients (≤ 60 years). With deaths recorded for 21 of 21 older patients, but only 9 of the 14 younger patients, 21-month survival for older vs. younger was 14 vs. 50% based on the 35 patients who entered the study at least 21 months ago (p = 0.036). Of the 46 patients evaluable for response, 63% had objectie remission on CHOP and another 20% remained stable. Conclusion: Combined modality therapy in this study did not produce an overall survival advantage in treating PCNSL. The 50% 21-month survival of younger patients may be a reflection of age only.

Original languageEnglish (US)
Pages (from-to)663-673
Number of pages11
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume33
Issue number3
DOIs
StatePublished - Oct 15 1995

Fingerprint

central nervous system
Non-Hodgkin's Lymphoma
therapy
Central Nervous System
Survival
Vincristine
Doxorubicin
Cyclophosphamide
Lymphoma
Therapeutics
chemotherapy
death
drugs
Combined Modality Therapy
transponders
Time and Motion Studies
Cytarabine
Adjuvant Chemotherapy
entry
Pharmaceutical Preparations

Keywords

  • Combined initial therapy
  • PCNSL

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Primary central nervous system non-hodgkin's lymphoma : Survival advantages with combined initial therapy? / O'Neill, Brian Patrick; O'Fallon, Judith R.; Earle, John D.; Colgan, Joseph P.; Brown, Loren D.; Krigel, Robert L.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 33, No. 3, 15.10.1995, p. 663-673.

Research output: Contribution to journalArticle

O'Neill, Brian Patrick ; O'Fallon, Judith R. ; Earle, John D. ; Colgan, Joseph P. ; Brown, Loren D. ; Krigel, Robert L. / Primary central nervous system non-hodgkin's lymphoma : Survival advantages with combined initial therapy?. In: International Journal of Radiation Oncology, Biology, Physics. 1995 ; Vol. 33, No. 3. pp. 663-673.
@article{5bad70b7110c4fa685ab264b77b87a5e,
title = "Primary central nervous system non-hodgkin's lymphoma: Survival advantages with combined initial therapy?",
abstract = "Purpose: Results of multiple radiation, chemotherapy, and combined treatment trials have shown that the fate of primary central nervous system lymphoma (PCNSL) patients is very different from that of patients with similarly treated systemic IE non-Hodgkin's lymphoma. This study was designed to improve the survival of PCNSL patients by the use of combined initial therapy. Methods and materials: Forty-six eligible primary PCNSL patients were treated with whole brain irradiation and adjuvant chemotherapy consisting of preirradiation cyclophosphamide-adriamycin-vincristine-prednisome (CHOP) and postirradiation high-dose cytosine arabinoside (HDAC) as part of an ongoing Phase II Mayo/North Central Cancer Treatmetn Group/Eastern Cooperative Oncology Group (M/NCCTG/ECOG) intergroup effort, which opened in April 1986. Results: This cohort consisted of 23 men and 23 women with median age 63.5 years (range 24 to 75 years). Only 5{\%} were under age 40; 36{\%} were age 40 to 59, 37{\%} were age 60 to 69, and 22{\%} were age 70 and over. Forty-six percent had good performance scores of ECOG 0-1 at time of study entry. Forty-six patients were evaluated for treatment outcome as of October 6, 1993. Of these, 10 were still alive. Estimated median survival and 21-month survival were 45.3 weeks and 29{\%}, respectively. There were deaths ranging from Day 9 to Day 15 (three drug-related, one from other complications), and two CHOP responders died at 32 and 35 days, soon after Cycle 2 of CHOP (one probably drug-related, one from other complications). There was no significant difference in survival according to baseline performance status. However, survival was consistently worse for patients > 60 years old than for the younger patients (≤ 60 years). With deaths recorded for 21 of 21 older patients, but only 9 of the 14 younger patients, 21-month survival for older vs. younger was 14 vs. 50{\%} based on the 35 patients who entered the study at least 21 months ago (p = 0.036). Of the 46 patients evaluable for response, 63{\%} had objectie remission on CHOP and another 20{\%} remained stable. Conclusion: Combined modality therapy in this study did not produce an overall survival advantage in treating PCNSL. The 50{\%} 21-month survival of younger patients may be a reflection of age only.",
keywords = "Combined initial therapy, PCNSL",
author = "O'Neill, {Brian Patrick} and O'Fallon, {Judith R.} and Earle, {John D.} and Colgan, {Joseph P.} and Brown, {Loren D.} and Krigel, {Robert L.}",
year = "1995",
month = "10",
day = "15",
doi = "10.1016/0360-3016(95)00207-F",
language = "English (US)",
volume = "33",
pages = "663--673",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Primary central nervous system non-hodgkin's lymphoma

T2 - Survival advantages with combined initial therapy?

AU - O'Neill, Brian Patrick

AU - O'Fallon, Judith R.

AU - Earle, John D.

AU - Colgan, Joseph P.

AU - Brown, Loren D.

AU - Krigel, Robert L.

PY - 1995/10/15

Y1 - 1995/10/15

N2 - Purpose: Results of multiple radiation, chemotherapy, and combined treatment trials have shown that the fate of primary central nervous system lymphoma (PCNSL) patients is very different from that of patients with similarly treated systemic IE non-Hodgkin's lymphoma. This study was designed to improve the survival of PCNSL patients by the use of combined initial therapy. Methods and materials: Forty-six eligible primary PCNSL patients were treated with whole brain irradiation and adjuvant chemotherapy consisting of preirradiation cyclophosphamide-adriamycin-vincristine-prednisome (CHOP) and postirradiation high-dose cytosine arabinoside (HDAC) as part of an ongoing Phase II Mayo/North Central Cancer Treatmetn Group/Eastern Cooperative Oncology Group (M/NCCTG/ECOG) intergroup effort, which opened in April 1986. Results: This cohort consisted of 23 men and 23 women with median age 63.5 years (range 24 to 75 years). Only 5% were under age 40; 36% were age 40 to 59, 37% were age 60 to 69, and 22% were age 70 and over. Forty-six percent had good performance scores of ECOG 0-1 at time of study entry. Forty-six patients were evaluated for treatment outcome as of October 6, 1993. Of these, 10 were still alive. Estimated median survival and 21-month survival were 45.3 weeks and 29%, respectively. There were deaths ranging from Day 9 to Day 15 (three drug-related, one from other complications), and two CHOP responders died at 32 and 35 days, soon after Cycle 2 of CHOP (one probably drug-related, one from other complications). There was no significant difference in survival according to baseline performance status. However, survival was consistently worse for patients > 60 years old than for the younger patients (≤ 60 years). With deaths recorded for 21 of 21 older patients, but only 9 of the 14 younger patients, 21-month survival for older vs. younger was 14 vs. 50% based on the 35 patients who entered the study at least 21 months ago (p = 0.036). Of the 46 patients evaluable for response, 63% had objectie remission on CHOP and another 20% remained stable. Conclusion: Combined modality therapy in this study did not produce an overall survival advantage in treating PCNSL. The 50% 21-month survival of younger patients may be a reflection of age only.

AB - Purpose: Results of multiple radiation, chemotherapy, and combined treatment trials have shown that the fate of primary central nervous system lymphoma (PCNSL) patients is very different from that of patients with similarly treated systemic IE non-Hodgkin's lymphoma. This study was designed to improve the survival of PCNSL patients by the use of combined initial therapy. Methods and materials: Forty-six eligible primary PCNSL patients were treated with whole brain irradiation and adjuvant chemotherapy consisting of preirradiation cyclophosphamide-adriamycin-vincristine-prednisome (CHOP) and postirradiation high-dose cytosine arabinoside (HDAC) as part of an ongoing Phase II Mayo/North Central Cancer Treatmetn Group/Eastern Cooperative Oncology Group (M/NCCTG/ECOG) intergroup effort, which opened in April 1986. Results: This cohort consisted of 23 men and 23 women with median age 63.5 years (range 24 to 75 years). Only 5% were under age 40; 36% were age 40 to 59, 37% were age 60 to 69, and 22% were age 70 and over. Forty-six percent had good performance scores of ECOG 0-1 at time of study entry. Forty-six patients were evaluated for treatment outcome as of October 6, 1993. Of these, 10 were still alive. Estimated median survival and 21-month survival were 45.3 weeks and 29%, respectively. There were deaths ranging from Day 9 to Day 15 (three drug-related, one from other complications), and two CHOP responders died at 32 and 35 days, soon after Cycle 2 of CHOP (one probably drug-related, one from other complications). There was no significant difference in survival according to baseline performance status. However, survival was consistently worse for patients > 60 years old than for the younger patients (≤ 60 years). With deaths recorded for 21 of 21 older patients, but only 9 of the 14 younger patients, 21-month survival for older vs. younger was 14 vs. 50% based on the 35 patients who entered the study at least 21 months ago (p = 0.036). Of the 46 patients evaluable for response, 63% had objectie remission on CHOP and another 20% remained stable. Conclusion: Combined modality therapy in this study did not produce an overall survival advantage in treating PCNSL. The 50% 21-month survival of younger patients may be a reflection of age only.

KW - Combined initial therapy

KW - PCNSL

UR - http://www.scopus.com/inward/record.url?scp=0028817810&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028817810&partnerID=8YFLogxK

U2 - 10.1016/0360-3016(95)00207-F

DO - 10.1016/0360-3016(95)00207-F

M3 - Article

C2 - 7558957

AN - SCOPUS:0028817810

VL - 33

SP - 663

EP - 673

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 3

ER -