Ravi Kumar1, Nadia Laack2, Bruce E Pollock3, Michael Link3, Brian P O'Neill4, Ian F Parney3. 1. Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: kumar.ravi@mayo.edu. 2. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA. 3. Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA. 4. Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Abstract
BACKGROUND: Central nervous system lymphoma (CNSL) is typically treated with chemotherapy and external beam radiation therapy (EBRT). Optimal management of recurrent CNSL is poorly defined. OBJECTIVE: We aim to determine the effectiveness of stereotactic radiosurgery in the treatment of recurrent CNSL. METHODS: We performed a retrospective analysis of patients having stereotactic radiosurgery (SRS) for recurrent intracranial CNSL between 1999 and 2011. RESULTS: Fourteen patients (20 tumors) underwent SRS. The median patient age was 71 years (range, 18-82 years). Seven patients (50%) had primary CNSL. All had received prior chemotherapy, and nine patients (64%) had undergone prior whole brain radiotherapy (WBRT) with a median dose of 40 Gy in 25 fractions. The median preoperative Karnofsky Performance Score was 80. The median tumor volume was 6.7 cm(3) (range, 0.5-37.7); the median margin dose was 15.5 Gy (range, 10-18). Eleven patients (79%) had tumor regression (n = 11) shown on MRI after SRS. The median overall survival after SRS was 9.5 months. No patient had a major radiation-related complication. CONCLUSION: Stereotactic radiosurgery for patients with recurrent CNSL is well tolerated and has a high rate of radiographic response. A marginal dose of 15.5 Gy or greater, a Karnofsky score of 80 or greater, and the absence of pre-SRS WBRT were associated with significantly longer overall survival. Stereotactic radiosurgery may be beneficial as an initial salvage therapy in the treatment of recurrent CNSL for properly selected patients.
BACKGROUND:Central nervous system lymphoma (CNSL) is typically treated with chemotherapy and external beam radiation therapy (EBRT). Optimal management of recurrent CNSL is poorly defined. OBJECTIVE: We aim to determine the effectiveness of stereotactic radiosurgery in the treatment of recurrent CNSL. METHODS: We performed a retrospective analysis of patients having stereotactic radiosurgery (SRS) for recurrent intracranial CNSL between 1999 and 2011. RESULTS: Fourteen patients (20 tumors) underwent SRS. The median patient age was 71 years (range, 18-82 years). Seven patients (50%) had primary CNSL. All had received prior chemotherapy, and nine patients (64%) had undergone prior whole brain radiotherapy (WBRT) with a median dose of 40 Gy in 25 fractions. The median preoperative Karnofsky Performance Score was 80. The median tumor volume was 6.7 cm(3) (range, 0.5-37.7); the median margin dose was 15.5 Gy (range, 10-18). Eleven patients (79%) had tumor regression (n = 11) shown on MRI after SRS. The median overall survival after SRS was 9.5 months. No patient had a major radiation-related complication. CONCLUSION: Stereotactic radiosurgery for patients with recurrent CNSL is well tolerated and has a high rate of radiographic response. A marginal dose of 15.5 Gy or greater, a Karnofsky score of 80 or greater, and the absence of pre-SRS WBRT were associated with significantly longer overall survival. Stereotactic radiosurgery may be beneficial as an initial salvage therapy in the treatment of recurrent CNSL for properly selected patients.
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