Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic radiosurgery in combination with up-front high-dose methotrexate as a first-line treatment for newly diagnosed primary central nervous system lymphoma

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

The efficacy of stereotactic radiosurgery (SRS) instead of whole brain radiotherapy (WBRT) following high-dose methotrexate (HD-MTX) for primary central nervous system lymphoma (PCNSL) is unclear. To clarify whether SRS in combination with up-front HD-MTX supplements the effect of HD-MTX in remaining or refractory lesions after initial HD-MTX treatment. The authors conducted a retrospective review for newly diagnosed PCNSL patients who underwent SRS after HD-MTX as a first-line treatment. The local control (LC), the progression-free survival (PFS), the recurrence patterns, the salvage treatments, the overall survival (OS), the Karnofsky Performance Status (KPS), the activities of daily living (ADL) were analyzed as well as radiosurgical parameters. Twenty patients underwent SRS for 51 lesions with the median volume of 0.45 cm3. The median age at SRS was 67 (range 37–82). The median KPS at SRS was 90. The LC rate at 2 years was 86.0 %, the median PFS after SRS was 17 months, necessitating additional SRS and chemotherapy. The median OS was 52 months. No significant side effects related to SRS were observed. During follow-up period, the good ADL preservation was achieved for 13 months from SRS. Patients with KPS ≥ 90 at SRS demonstrated longer ADL preservation (32 months from SRS). SRS following up-front HD-MTX without WBRT provided excellent LC, acceptable OS and the long ADL preservation period. These benefits may be more emphasized especially in patients with good KPS, but should be validated in a large patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Batchelor T, Carson K, O’Neill A, Grossman SA, Alavi J, New P, Hochberg F, Priet R (2003) Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol 21(6):1044–1049

    Article  CAS  PubMed  Google Scholar 

  2. Herrlinger U, Kuker W, Uhl M, Blaicher HP, Karnath HO, Kanz L, Bamberg M, Weller M (2005) NOA-03 trial of high-dose methotrexate in primary central nervous system lymphoma: final report. Ann Neurol 57(6):843–847. doi:10.1002/ana.20495

    Article  CAS  PubMed  Google Scholar 

  3. Thiel E, Korfel A, Martus P, Kanz L, Griesinger F, Rauch M, Roth A, Hertenstein B, von Toll T, Hundsberger T, Mergenthaler HG, Leithauser M, Birnbaum T, Fischer L, Jahnke K, Herrlinger U, Plasswilm L, Nagele T, Pietsch T, Bamberg M, Weller M (2010) High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol 11(11):1036–1047. doi:10.1016/S1470-2045(10)70229-1

    Article  CAS  PubMed  Google Scholar 

  4. Citterio G, Ferreri AJ, Reni M (2013) Current uses of radiation therapy in patients with primary CNS lymphoma. Expert Rev Anticancer Ther 13(11):1327–1337. doi:10.1586/14737140.2013.851007

    Article  CAS  PubMed  Google Scholar 

  5. Omuro AM, Ben-Porat LS, Panageas KS, Kim AK, Correa DD, Yahalom J, Deangelis LM, Abrey LE (2005) Delayed neurotoxicity in primary central nervous system lymphoma. Arch Neurol 62(10):1595–1600. doi:10.1001/archneur.62.10.1595

    Article  PubMed  Google Scholar 

  6. Correa DD, Shi W, Abrey LE, Deangelis LM, Omuro AM, Deutsch MB, Thaler HT (2012) Cognitive functions in primary CNS lymphoma after single or combined modality regimens. Neuro Oncol 14(1):101–108. doi:10.1093/neuonc/nor186

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Roth P, Stupp R, Eisele G, Weller M (2014) Treatment of primary CNS lymphoma. Curr Treat Options Neurol 16(1):277. doi:10.1007/s11940-013-0277-y

    Article  PubMed  Google Scholar 

  8. Dalia S, Forsyth P, Chavez J, Price S, Shah B, Bello C, Sokol L, Pan E, Sotomayor E, Lee JH, Fisher K, Jaglal M (2014) Primary B-cell CNS lymphoma clinicopathologic and treatment outcomes in 89 patients from a single tertiary care center. Int J Hematol 99(4):450–456. doi:10.1007/s12185-014-1540-z

    Article  CAS  PubMed  Google Scholar 

  9. Rubenstein JL, Hsi ED, Johnson JL, Jung SH, Nakashima MO, Grant B, Cheson BD, Kaplan LD (2013) Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS lymphoma: CALGB 50202 (Alliance 50202). J Clin Oncol 31(25):3061–3068. doi:10.1200/JCO.2012.46.9957

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Ferreri AJ, Ciceri F, Brandes AA, Montanari M, Balzarotti M, Spina M, Ilariucci F, Zaja F, Stelitano C, Bobbio F, Corazzelli G, Baldini L, Reni M (2014) MATILDE chemotherapy regimen for primary CNS lymphoma: results at a median follow-up of 12 years. Neurology 82(15):1370–1373. doi:10.1212/WNL.0000000000000314

    Article  CAS  PubMed  Google Scholar 

  11. Morris PG, Correa DD, Yahalom J, Raizer JJ, Schiff D, Grant B, Grimm S, Lai RK, Reiner AS, Panageas K, Karimi S, Curry R, Shah G, Abrey LE, DeAngelis LM, Omuro A (2013) Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome. J Clin Oncol 31(31):3971–3979. doi:10.1200/JCO.2013.50.4910

    Article  CAS  PubMed  Google Scholar 

  12. Kim YR, Kim SH, Chang JH, Suh CO, Kim SJ, Kim Y, Hwang DY, Jang JE, Hyun SY, Cheong JW, Min YH, Kim JS (2014) Early response to high-dose methotrexate, vincristine, and procarbazine chemotherapy-adapted strategy for primary CNS lymphoma: no consolidation therapy for patients achieving early complete response. Ann Hematol 93(2):211–219. doi:10.1007/s00277-013-1853-7

    Article  CAS  PubMed  Google Scholar 

  13. Villano JL, Koshy M, Shaikh H, Dolecek TA, McCarthy BJ (2011) Age, gender, and racial differences in incidence and survival in primary CNS lymphoma. Br J Cancer 105(9):1414–1418. doi:10.1038/bjc.2011.357

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Kondziolka D, Shin SM, Brunswick A, Kim I, Silverman JS (2014) The biology of radiosurgery and its clinical applications for brain tumors. Neuro Oncol 17(1):29–44. doi:10.1093/neuonc/nou284

    Article  PubMed  Google Scholar 

  15. Pollock BE, Stafford SL, Link MJ, Garces YI, Foote RL (2012) Stereotactic radiosurgery of World Health Organization grade II and III intracranial meningiomas: treatment results on the basis of a 22-year experience. Cancer 118(4):1048–1054. doi:10.1002/cncr.26362

    Article  PubMed  Google Scholar 

  16. Kenai H, Yamashita M, Nakamura T, Asano T, Momii Y, Nagatomi H (2006) Gamma Knife surgery for primary central nervous system lymphoma: usefulness as palliative local tumor control. J Neurosurg 105(Suppl):133–138. doi:10.3171/sup.2006.105.7.133

    PubMed  Google Scholar 

  17. Matsumoto Y, Horiike S, Fujimoto Y, Shimizu D, Kudo-Nakata Y, Kimura S, Sato M, Nomura K, Kaneko H, Kobayashi Y, Shimazaki C, Taniwaki M (2007) Effectiveness and limitation of gamma knife radiosurgery for relapsed central nervous system lymphoma: a retrospective analysis in one institution. Int J Hematol 85(4):333–337. doi:10.1532/IJH97.06205

    Article  PubMed  Google Scholar 

  18. Sakamoto M, Oya N, Mizowaki T, Araki N, Nagata Y, Takayama K, Takahashi JA, Kano H, Katsuki T, Hashimioto N, Hiraoka M (2006) Initial experiences of palliative stereotactic radiosurgery for recurrent brain lymphomas. J Neuro Oncol 77(1):53–58. doi:10.1007/s11060-005-7698-8

    Article  Google Scholar 

  19. Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro Oncol 15(Suppl 2):ii1–ii56. doi:10.1093/neuonc/not151

    Article  PubMed Central  PubMed  Google Scholar 

  20. Doolittle ND, Korfel A, Lubow MA, Schorb E, Schlegel U, Rogowski S, Fu R, Dosa E, Illerhaus G, Kraemer DF, Muldoon LL, Calabrese P, Hedrick N, Tyson RM, Jahnke K, Maron LM, Butler RW, Neuwelt EA (2013) Long-term cognitive function, neuroimaging, and quality of life in primary CNS lymphoma. Neurology 81(1):84–92. doi:10.1212/WNL.0b013e318297eeba

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Guha-Thakurta N, Damek D, Pollack C, Hochberg FH (1999) Intravenous methotrexate as initial treatment for primary central nervous system lymphoma: response to therapy and quality of life of patients. J Neuro Oncol 43(3):259–268

    Article  CAS  Google Scholar 

  22. Gerstner ER, Carson KA, Grossman SA, Batchelor TT (2008) Long-term outcome in PCNSL patients treated with high-dose methotrexate and deferred radiation. Neurology 70(5):401–402. doi:10.1212/01.wnl.0000300671.37279.0e

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This work was not supported by any grants.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba, 260-8670, Japan

    Seiichiro Hirono, Yasuo Iwadate, Yoshinori Higuchi, Tomoro Matsutani & Naokatsu Saeki

  2. Tokyo Gamma Unit Center, Tsukiji Neurologic Clinic, 1-9-9 Tsukiji, Chuoku, Tokyo, 104-0045, Japan

    Toru Serizawa

  3. Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan

    Osamu Nagano

Authors
  1. Seiichiro Hirono
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuo Iwadate
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshinori Higuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toru Serizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osamu Nagano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomoro Matsutani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naokatsu Saeki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seiichiro Hirono.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirono, S., Iwadate, Y., Higuchi, Y. et al. Stereotactic radiosurgery in combination with up-front high-dose methotrexate as a first-line treatment for newly diagnosed primary central nervous system lymphoma. J Neurooncol 123, 237–244 (2015). https://doi.org/10.1007/s11060-015-1786-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-015-1786-1

Keywords

Search

Navigation