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Title: CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma

Abstract

Purpose: To assess the efficacy and toxicity of chemotherapy consisting of cyclophosphamide, doxorubicin (Adriamycin), vincristine, and dexamethasone (CHOD) plus bis-chloronitrosourea (BCNU), cytosine arabinoside, and methotrexate (BVAM) followed by whole-brain irradiation (WBRT) for patients with primary central nervous system lymphoma (PCNSL). Methods and Materials: Patients 70 years old and younger with newly diagnosed, biopsy-proven PCNSL received one cycle of CHOD followed by two cycles of BVAM. Patients then received WBRT, 30.6 Gy, if a complete response was evoked, or 50.4 Gy if the response was less than complete; both doses were given in 1.8-Gy daily fractions. The primary efficacy endpoint was 1-year survival. Results: Thirty-six patients (19 men, 17 women) enrolled between 1995 and 2000. Median age was 60.5 years (range, 34 to 69 years). Thirty (83%) patients had baseline Eastern Cooperative Oncology Group performance scores of 0 to 1. All 36 patients were eligible for survival and response evaluations. Median time to progression was 12.3 months, and median survival was 18.5 months. The percentages of patients alive at 1, 2, and 3 years were 64%, 36%, and 33%, respectively. The best response was complete response in 10 patients and immediate progression in 7 patients. Ten (28%) patients had at leastmore » one grade 3 or higher neurologic toxicity. Conclusions: This regimen did improve the survival of PCNSL patients but also caused substantial toxicity. The improvement in survival is less than that reported with high-dose methotrexate-based therapies.« less

Authors:
 [1];  [2]; ; ;  [3]; ;  [4];  [1]; ;  [5];  [6];  [7];  [8];  [9];  [5];  [10]
  1. Department of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota (United States)
  2. Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota (United States)
  3. Division of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota (United States)
  4. Department of Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota (United States)
  5. Division of Hematology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota (United States)
  6. Department of Neuro-Oncology, The M.D. Anderson Cancer Center, Houston, Texas (United States)
  7. Oschner CCOP, New Orleans, Louisiana (United States)
  8. Iowa Oncology Research Association CCOP, Des Moines, Iowa (United States)
  9. CentraCare Clinic, St. Cloud, Minnesota (United States)
  10. Colorado Cancer Research Program, Denver, Colorado (United States)
Publication Date:
OSTI Identifier:
21587738
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 81; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2010.06.002; PII: S0360-3016(10)00786-8; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOPSY; BRAIN; CHEMOTHERAPY; CYTOSINE; DEXAMETHASONE; DOXORUBICIN; ENDOXAN; IRRADIATION; LYMPHOMAS; METHOTREXATE; RADIATION DOSES; RADIOTHERAPY; TOXICITY; ADRENAL HORMONES; ALKYLATING AGENTS; AMINES; ANTIBIOTICS; ANTI-INFECTIVE AGENTS; ANTIMETABOLITES; ANTINEOPLASTIC DRUGS; AZINES; BODY; CENTRAL NERVOUS SYSTEM; CORTICOSTEROIDS; DIAGNOSTIC TECHNIQUES; DISEASES; DOSES; DRUGS; GLUCOCORTICOIDS; HETEROCYCLIC COMPOUNDS; HORMONES; HYDROXY COMPOUNDS; IMMUNE SYSTEM DISEASES; IMMUNOSUPPRESSIVE DRUGS; KETONES; MEDICINE; NEOPLASMS; NERVOUS SYSTEM; NUCLEAR MEDICINE; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANIC OXYGEN COMPOUNDS; ORGANS; PREGNANES; PYRIMIDINES; RADIOLOGY; STEROID HORMONES; STEROIDS; THERAPY

Citation Formats

Laack, Nadia N., O'Neill, Brian Patrick, E-mail: boneill@mayo.edu, Ballman, Karla V., O'Fallon, Judith Rich, Carrero, Xiomara W., Kurtin, Paul J., Scheithauer, Bernd W., Brown, Paul D., Habermann, Thomas M., Colgan, Joseph P., Gilbert, Mark R., Hawkins, Roland B., Morton, Roscoe F., Windschitl, Harry E., Fitch, Tom R., and Pajon, Eduardo R. CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.06.002.
Laack, Nadia N., O'Neill, Brian Patrick, E-mail: boneill@mayo.edu, Ballman, Karla V., O'Fallon, Judith Rich, Carrero, Xiomara W., Kurtin, Paul J., Scheithauer, Bernd W., Brown, Paul D., Habermann, Thomas M., Colgan, Joseph P., Gilbert, Mark R., Hawkins, Roland B., Morton, Roscoe F., Windschitl, Harry E., Fitch, Tom R., & Pajon, Eduardo R. CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma. United States. doi:10.1016/j.ijrobp.2010.06.002.
Laack, Nadia N., O'Neill, Brian Patrick, E-mail: boneill@mayo.edu, Ballman, Karla V., O'Fallon, Judith Rich, Carrero, Xiomara W., Kurtin, Paul J., Scheithauer, Bernd W., Brown, Paul D., Habermann, Thomas M., Colgan, Joseph P., Gilbert, Mark R., Hawkins, Roland B., Morton, Roscoe F., Windschitl, Harry E., Fitch, Tom R., and Pajon, Eduardo R. Sat . "CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma". United States. doi:10.1016/j.ijrobp.2010.06.002.
@article{osti_21587738,
title = {CHOD/BVAM Chemotherapy and Whole-Brain Radiotherapy for Newly Diagnosed Primary Central Nervous System Lymphoma},
author = {Laack, Nadia N. and O'Neill, Brian Patrick, E-mail: boneill@mayo.edu and Ballman, Karla V. and O'Fallon, Judith Rich and Carrero, Xiomara W. and Kurtin, Paul J. and Scheithauer, Bernd W. and Brown, Paul D. and Habermann, Thomas M. and Colgan, Joseph P. and Gilbert, Mark R. and Hawkins, Roland B. and Morton, Roscoe F. and Windschitl, Harry E. and Fitch, Tom R. and Pajon, Eduardo R.},
abstractNote = {Purpose: To assess the efficacy and toxicity of chemotherapy consisting of cyclophosphamide, doxorubicin (Adriamycin), vincristine, and dexamethasone (CHOD) plus bis-chloronitrosourea (BCNU), cytosine arabinoside, and methotrexate (BVAM) followed by whole-brain irradiation (WBRT) for patients with primary central nervous system lymphoma (PCNSL). Methods and Materials: Patients 70 years old and younger with newly diagnosed, biopsy-proven PCNSL received one cycle of CHOD followed by two cycles of BVAM. Patients then received WBRT, 30.6 Gy, if a complete response was evoked, or 50.4 Gy if the response was less than complete; both doses were given in 1.8-Gy daily fractions. The primary efficacy endpoint was 1-year survival. Results: Thirty-six patients (19 men, 17 women) enrolled between 1995 and 2000. Median age was 60.5 years (range, 34 to 69 years). Thirty (83%) patients had baseline Eastern Cooperative Oncology Group performance scores of 0 to 1. All 36 patients were eligible for survival and response evaluations. Median time to progression was 12.3 months, and median survival was 18.5 months. The percentages of patients alive at 1, 2, and 3 years were 64%, 36%, and 33%, respectively. The best response was complete response in 10 patients and immediate progression in 7 patients. Ten (28%) patients had at least one grade 3 or higher neurologic toxicity. Conclusions: This regimen did improve the survival of PCNSL patients but also caused substantial toxicity. The improvement in survival is less than that reported with high-dose methotrexate-based therapies.},
doi = {10.1016/j.ijrobp.2010.06.002},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 81,
place = {United States},
year = {2011},
month = {10}
}