Division of Neuro Oncology, Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea.
Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea.
Curr Oncol. 2021 Nov 12;28(6):4655-4672. doi: 10.3390/curroncol28060393.
The Radiation Therapy Oncology Group (RTOG) 9310 protocol clinical trial established high-dose methotrexate (HDMTX) as the standard for primary central nervous system lymphoma (PCNSL). We aimed to investigate the RTOG 9310 protocol's PCNSL outcomes by examining progression-free survival (PFS) and overall survival (OS) rates and determining the influential factors. Between 2007 and 2020, 87 patients were histopathologically diagnosed with PCNSL and treated with the RTOG 9310 protocol. All received HDMTX 2.5 g/m and vincristine 1.4 mg/m/day for 1 day during weeks 1, 3, 5, 7, and 9, and procarbazine 100 mg/m/day for 1 day during weeks 1, 5, and 9. Dexamethasone was administered on a standard tapering schedule from the first week to the sixth week. Whole brain radiotherapy (WBRT), consisting of 45 Gy for patients with less than a complete response to the chemotherapy or 36 Gy for complete responders, was started 1 week after the last dose of chemotherapy was administered. Within three weeks of the completion of WBRT, patients received two courses of cytarabine, which were separated by 3-4 weeks. Clinical, radiological, and histopathological characteristics were retrospectively reviewed. All patients completed five HDMTX cycles and a mean follow-up of 60.2 (range, 6-150) months. Twenty-eight (32.2%) patients experienced recurrence during follow-up. The mean time to recurrence was 21.8 months, while the mean PFS was 104.3 (95% confidence interval (CI), 90.6-118.0) months. Eleven (12.6%) patients died; the mean OS was 132.1 (95% CI, 122.2-141.9) months. The 3- and 5-year survival rates were 92.0% and 87.4%, respectively. One patient experienced acute renal failure, while the remainder tolerated any cytotoxic side effects. On multivariate analysis, the Eastern Cooperative Oncology Group performance score ≤ 2; the International Extranodal Lymphoma Study Group low-risk status; XBP-1, p53, and c-Myc negativity; homogenous enhancement; gross total resection, independently correlated with long PFS and OS. The RTOG 9310 protocol is effective for PCNSL and features good outcomes.
罗切斯特大学放射肿瘤学组（RTOG）9310 方案临床试验将高剂量甲氨蝶呤（HDMTX）确立为原发性中枢神经系统淋巴瘤（PCNSL）的标准治疗方法。我们旨在通过检查无进展生存期（PFS）和总生存期（OS）率并确定影响因素来研究 RTOG 9310 方案治疗 PCNSL 的结果。2007 年至 2020 年间，87 例患者经组织病理学诊断为 PCNSL，并接受 RTOG 9310 方案治疗。所有患者在第 1、3、5、7 和 9 周的 1 天内接受 2.5 g/m 的 HDMTX 和 1.4 mg/m 的长春新碱，在第 1、5 和 9 周的 1 天内接受 100 mg/m 的丙卡巴肼。地塞米松在第 1 周到第 6 周按照标准方案逐渐减量。在最后一次化疗后 1 周开始进行全脑放疗（WBRT），对于化疗反应不完全的患者给予 45 Gy，对于完全缓解的患者给予 36 Gy。WBRT 完成后 3 周内，患者接受两个疗程的阿糖胞苷治疗，间隔 3-4 周。回顾性分析临床、影像学和组织病理学特征。所有患者均完成 5 个 HDMTX 周期，中位随访时间为 60.2 个月（范围 6-150 个月）。28 例（32.2%）患者在随访期间复发。中位复发时间为 21.8 个月，中位 PFS 为 104.3 个月（95%置信区间（CI）：90.6-118.0）。11 例（12.6%）患者死亡，中位 OS 为 132.1 个月（95%CI：122.2-141.9）。1 例患者出现急性肾衰竭，其余患者均能耐受任何细胞毒性副作用。多因素分析显示，Eastern Cooperative Oncology Group 表现状态评分≤2、国际结外淋巴瘤研究组低危状态、XBP-1、p53 和 c-Myc 阴性、均匀强化、大体全切除与长 PFS 和 OS 独立相关。RTOG 9310 方案治疗 PCNSL 有效，疗效良好。
