Treatment of relapsed central nervous system lymphoma

Abstract

Although therapeutic protocols involving high-dose MTX yield relatively favorable results against primary central nervous system malignant lymphoma, it is still rare for this type of tumor to be cured by this approach. Recently, new protocols and guidelines for refractory or relapsed primary CNS lymphomas were reported. These protocols include repeated high-dose MTX therapy, salvage therapy with temozolomide or topotecan, intraventricular treatment with rituximab, and clinical practice guidelines in oncology-v. 1. 2004, NCCN. Under these circumstances, we evaluated the efficacy of stereotactic radiosurgery administered as an additional therapy in cases with partial remission or recurrent cases of this tumor. Forty two patients were initially treated at our facility by chemotherapy with MTX followed by whole-brain irradiation. Of these, 7 patients who had shown partial remission after initial treatment and 7 other patients who had developed tumor recurrence during follow-up received regional stereotactic radiosurgery. The mean survival period after tumor recurrence was 27 months. When the outcomes of the 42 patients were analyzed, the median survival period after the start of initial treatment was extended to 64 months. These results indicate that stereotactic radiosurgery is useful for treating malignant lymphoma of the CNS where the disease remains unremitting or has recurred after initial treatment.