Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: Prolonged survival and preservation of cognitive function

Edward A. Neuwelt, David L. Goldman, Suellen A. Dahlborg, John Crossen, Fred Ramsey, Simon Roman-Goldstein, Rita Braziel, Bruce Dana

Research output: Contribution to journalArticle

294 Scopus citations

Abstract

Combination chemotherapy with or without radiotherapy has had only modest efficacy in the treatment of primary CNS lymphoma. Median survival of these patients, treated primarily with radiotherapy, is 13 months; 5-year survival is less than 5%. Thirty consecutive non-acquired immune deficiency syndrome patients with primary CNS lymphoma were treated with barrier-dependent chemotherapy using intraarterial mannitol to open the blood-brain barrier (BBB). Follow-up included extensive neuropsychologic testing of all patients. Thirteen patients received cranial radiation 1 to 9 months before referral (group 1). Seventeen patients received initial BBB disruption chemotherapy with subsequent radiation only for tumor progression or recurrence (group 2). The difference in median survivals from diagnosis - 17.8 months for group 1 and 44.5 months for group 2 - was statistically significant (P = .039). Group 1 survival is comparable with the 20-month median survival of a historical series of patients (n = 208) treated with radiotherapy with or without chemotherapy. Group 2 patient survival represents an advance in the survival of CNS lymphoma and was associated with preservation of cognitive function in six of seven nonirradiated complete responders observed for 1 to 7 years. Patient toxicity was manageable in this intensive therapeutic regimen. In this series, a plateau in survival curves suggests that a major portion of these patients may be cured without the neuropsychologic sequelae associated with cranial radiation.

Original languageEnglish (US)
Pages (from-to)1580-1590
Number of pages11
JournalJournal of Clinical Oncology
Volume9
Issue number9
DOIs
StatePublished - Sep 1991

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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