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Characteristics and outcomes of elderly patients with primary central nervous system lymphoma: the Memorial Sloan-Kettering Cancer Center experience Ney DE; Reiner AS; Panageas KS; Brown HS; DeAngelis LM; Abrey LECancer 2010[Oct]; 116 (19): 4605-12BACKGROUND: Approximately 50% of all patients with primary central nervous system lymphoma (PCNSL) are aged >/=65 years; however, this group is relatively understudied, and to the authors's knowledge, optimal treatment for older patients is not well defined. METHODS: This was a retrospective review of PCNSL patients aged >/=65 years who were treated at Memorial Sloan-Kettering Cancer Center between 1986 and 2008. A multivariate analysis of demographic and clinical variables on prognosis and receipt of treatment was performed. RESULTS: One hundred seventy-four patients between the ages of 65 and 89 years were identified; there was a slight predominance of women (52.9%). One hundred forty-eight patients were treated with chemotherapy at the time of diagnosis (98% with methotrexate-based therapy) and 31 of these patients also received whole-brain radiotherapy (WBRT). Sixteen patients received WBRT alone. A radiographic response to chemotherapy was noted in 76% of patients. Ninety patients developed disease progression after initial treatment; 74 received salvage therapy and 48% of these patients responded to salvage treatment. The median overall survival was 25 months (range, 18-33 months), and the 3-year survival rate was 36%. Approximately 20.1% of patients were alive for >/=11 years. WBRT was delivered more frequently before 1998, and patients with a history of prior malignancy were less likely to receive WBRT. Age and performance status were identified as the most important predictors of survival. Treatment-related neurotoxicity at 2 years was strongly associated with receipt of WBRT (P=.0002). CONCLUSIONS: PCNSL in the elderly remains sensitive to methotrexate-based chemotherapy and aggressive treatment may be warranted both at the time of diagnosis and disease recurrence.|Age Factors[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Antineoplastic Combined Chemotherapy Protocols/therapeutic use[MESH]|Brain Neoplasms[MESH]|Central Nervous System Neoplasms/drug therapy/mortality/radiotherapy/*therapy[MESH]|Combined Modality Therapy[MESH]|Disease-Free Survival[MESH]|Female[MESH]|Humans[MESH]|Lymphoma, Non-Hodgkin/drug therapy/mortality/radiotherapy/*therapy[MESH]|Male[MESH]|Survival Rate[MESH]|Treatment Outcome[MESH] |
