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Omitting radiation did not reduce survival in CNS lymphoma
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Among patients with primary central nervous system lymphoma assigned high-dose methotrexate, researchers found no statistically significant difference in survival between those who underwent subsequent radiation therapy and those who did not.
Researchers recruited 551 patients with newly diagnosed primary CNS lymphoma from 75 treatment centers in Germany from May 2000 to May 2009. All patients were assigned first-line chemotherapy with six cycles of 4 g/m2 IV methotrexate and six cycles of high-dose methotrexate plus g/m2 1.5 IV ifosfamide.
There were 208 patients assigned to chemotherapy without radiation. Ninety-six patients had complete response and underwent no further treatment. Another 164 patients subsequently had complete remission or received high-dose cytarabine.
Patients randomly assigned to whole-brain radiotherapy (n=203) were given 45 Gy in 30 daily fractions of 1.5 Gy.
After chemotherapy, 45% of patients assigned radiotherapy and 25% assigned cytarabine had complete response.
At a median follow-up of 53.7 months, median OS was 21.5 months for the entire cohort and 35.3 months for those in the per-protocol population.
Two-year PFS was 43.5% (95% CI, 35.3-51.7) in the whole-brain radiotherapy group and 30.7% (23.1-38.3) in the chemotherapy-alone group. Univariate analysis showed no significant difference between the study groups for PFS or OS.
No significant differences were recorded for PFS or OS in patients from both treatment groups assigned high-dose methotrexate compared with those assigned methotrexate plus ifosfamide.
For more information:
- Thiel E. Lancet Oncol. 2010;doi:10.1016/S1470-2045(10)70229-1.