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Original article
peer-reviewed

A Regional Multicenter Retrospective Analysis of Patients with Primary Central Nervous System Lymphoma Diagnosed from 2000-2012: Treatment Patterns and Clinical Outcomes



Abstract

Introduction

Primary central nervous system lymphoma (PCNSL) is a rare tumor without a well-defined standard of care. For immunocompetent patients, therapeutic regimens have largely evolved from treatment with whole-brain radiation therapy (WBRT) to treating initially with systemic chemotherapy regimens that include high-dose (HD) methotrexate (MTX) with or without WBRT. Looking at population-based treatment trends may help define which therapies are most effective. This study was conducted to determine treatment patterns and outcomes for patients with PCNSL in the Louisville, KY metropolitan area during the period 2000 to 2012.

Methods

Data were collected by retrospective chart reviews of patients identified using the International Classification of Diseases (ICD) code from three major oncology practices in the Louisville metropolitan area during the period 2000 to 2012. Patients were excluded if they were under age 18, positive for human immunodeficiency virus (HIV), had histology other than B-cell lymphoma, or had systemic lymphoma.

Results

A total of 21 patients were identified. The median age was 65 years (range: 30 to 90). All patients were Caucasian, and the median Karnofsky performance status (KPS) score was 80 (range: 50 to 100). The ratio of males to females was 1:1.3. Median overall survival (OS) for all patients was 22 months (range: 1 to 155 months). Of 21 patients, 11 (52 percent) received chemotherapy regimens that included systemic HD-MTX at their initial diagnosis with a median OS of 22 months (range: 1 to 155 months). Nine of 21 patients (42 patients) were offered other therapies, including WBRT or non-MTX-based chemotherapies; they had a median OS of 5 months (range: 2 to 150 months). The median OS for patients receiving at least four cycles of HD-MTX was 40 months (range: 4 to 155 months).

Conclusions

This population-based study shows that patients with PCNSL and the ability to undergo HD-MTX-based therapy had a superior survival rate compared to those receiving radiation alone or other non-HD-MTX-based therapies. 



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Original article
peer-reviewed

A Regional Multicenter Retrospective Analysis of Patients with Primary Central Nervous System Lymphoma Diagnosed from 2000-2012: Treatment Patterns and Clinical Outcomes


Author Information

Eric C. Burton Corresponding Author

Department of Neurology, University of Louisville

Beatrice Ugiliweneza

Department of Neurosurgery, University of Louisville

Murali K. Kolikonda

Department of Neurology, University of Louisville

Tanuj Saaraswat

Department of Neurology, University of Louisville

Shiao Woo

Radiation Oncology, University of Louisville

Maxwell Boakye

Department of Neurosurgery, University of Louisville

Lennea Coombs

Oncology, Norton Cancer Institute

Renato LaRocca

Oncology, Norton Cancer Institute

Aaron Spalding

Radiation Oncology, Norton Cancer Institute


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

A Regional Multicenter Retrospective Analysis of Patients with Primary Central Nervous System Lymphoma Diagnosed from 2000-2012: Treatment Patterns and Clinical Outcomes


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Original article
peer-reviewed

A Regional Multicenter Retrospective Analysis of Patients with Primary Central Nervous System Lymphoma Diagnosed from 2000-2012: Treatment Patterns and Clinical Outcomes

Eric C. Burton">Eric C. Burton , Beatrice Ugiliweneza">Beatrice Ugiliweneza, Murali K. Kolikonda">Murali K. Kolikonda, Tanuj Saaraswat">Tanuj Saaraswat, Shiao Woo">Shiao Woo, Maxwell Boakye">Maxwell Boakye, Lennea Coombs">Lennea Coombs, Renato LaRocca">Renato LaRocca, Aaron Spalding">Aaron Spalding

  • Author Information
    Eric C. Burton Corresponding Author

    Department of Neurology, University of Louisville

    Beatrice Ugiliweneza

    Department of Neurosurgery, University of Louisville

    Murali K. Kolikonda

    Department of Neurology, University of Louisville

    Tanuj Saaraswat

    Department of Neurology, University of Louisville

    Shiao Woo

    Radiation Oncology, University of Louisville

    Maxwell Boakye

    Department of Neurosurgery, University of Louisville

    Lennea Coombs

    Oncology, Norton Cancer Institute

    Renato LaRocca

    Oncology, Norton Cancer Institute

    Aaron Spalding

    Radiation Oncology, Norton Cancer Institute


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: July 25, 2017

    DOI

    10.7759/cureus.1512

    Cite this article as:

    Burton E C, Ugiliweneza B, Kolikonda M K, et al. (July 25, 2017) A Regional Multicenter Retrospective Analysis of Patients with Primary Central Nervous System Lymphoma Diagnosed from 2000-2012: Treatment Patterns and Clinical Outcomes. Cureus 9(7): e1512. doi:10.7759/cureus.1512

    Publication history

    Received by Cureus: June 20, 2017
    Peer review began: July 13, 2017
    Peer review concluded: July 21, 2017
    Published: July 25, 2017

    Copyright

    © Copyright 2017
    Burton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

Primary central nervous system lymphoma (PCNSL) is a rare tumor without a well-defined standard of care. For immunocompetent patients, therapeutic regimens have largely evolved from treatment with whole-brain radiation therapy (WBRT) to treating initially with systemic chemotherapy regimens that include high-dose (HD) methotrexate (MTX) with or without WBRT. Looking at population-based treatment trends may help define which therapies are most effective. This study was conducted to determine treatment patterns and outcomes for patients with PCNSL in the Louisville, KY metropolitan area during the period 2000 to 2012.

Methods

Data were collected by retrospective chart reviews of patients identified using the International Classification of Diseases (ICD) code from three major oncology practices in the Louisville metropolitan area during the period 2000 to 2012. Patients were excluded if they were under age 18, positive for human immunodeficiency virus (HIV), had histology other than B-cell lymphoma, or had systemic lymphoma.

Results

A total of 21 patients were identified. The median age was 65 years (range: 30 to 90). All patients were Caucasian, and the median Karnofsky performance status (KPS) score was 80 (range: 50 to 100). The ratio of males to females was 1:1.3. Median overall survival (OS) for all patients was 22 months (range: 1 to 155 months). Of 21 patients, 11 (52 percent) received chemotherapy regimens that included systemic HD-MTX at their initial diagnosis with a median OS of 22 months (range: 1 to 155 months). Nine of 21 patients (42 patients) were offered other therapies, including WBRT or non-MTX-based chemotherapies; they had a median OS of 5 months (range: 2 to 150 months). The median OS for patients receiving at least four cycles of HD-MTX was 40 months (range: 4 to 155 months).

Conclusions

This population-based study shows that patients with PCNSL and the ability to undergo HD-MTX-based therapy had a superior survival rate compared to those receiving radiation alone or other non-HD-MTX-based therapies. 



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Eric C. Burton

Department of Neurology, University of Louisville

For correspondence:
eric.burton@louisville.edu

Beatrice Ugiliweneza

Department of Neurosurgery, University of Louisville

Murali K. Kolikonda

Department of Neurology, University of Louisville

Tanuj Saaraswat

Department of Neurology, University of Louisville

Shiao Woo

Radiation Oncology, University of Louisville

Maxwell Boakye

Department of Neurosurgery, University of Louisville

Lennea Coombs

Oncology, Norton Cancer Institute

Renato LaRocca

Oncology, Norton Cancer Institute

Aaron Spalding

Radiation Oncology, Norton Cancer Institute

Eric C. Burton

Department of Neurology, University of Louisville

For correspondence:
eric.burton@louisville.edu

Beatrice Ugiliweneza

Department of Neurosurgery, University of Louisville

Murali K. Kolikonda

Department of Neurology, University of Louisville

Tanuj Saaraswat

Department of Neurology, University of Louisville

Shiao Woo

Radiation Oncology, University of Louisville

Maxwell Boakye

Department of Neurosurgery, University of Louisville

Lennea Coombs

Oncology, Norton Cancer Institute

Renato LaRocca

Oncology, Norton Cancer Institute

Aaron Spalding

Radiation Oncology, Norton Cancer Institute