PREIRRADIATION METHOTREXATE CHEMOTHERAPY OF PRIMARY CENTRAL-NERVOUS-SYSTEM LYMPHOMA - LONG-TERM OUTCOME

The treatment of primary central nervous system lymphoma with chemothe rapy prior to whole-brain radiation therapy (WBRT) has improved outcom e considerably in this previously fatal disease. Complete or partial r esponses to intravenous methotrexate (3.5 gm/sq m with leucovorin resc ue every 3 weeks for two to four cycles) were seen in 12 of 13 patient s originally treated. A total of 25 patients (including the original 1 3) have now been treated with one to six cycles of methotrexate every 10 to 21 days prior to WBRT. Twenty-two had partial or complete respon ses, with a median duration of response of 32 months. Median survival time was 33 months (42.5 months in those responding to therapy). Nine patients are alive and without evidence of disease 9 to 122 months fol lowing therapy. Acute and long-term toxicities were minimal. Systemic methotrexate administration prior to WBRT is well tolerated and produc es long-term survival.