Treatment of Primary CNS Lymphoma in the Elderly, a Multicenter Retrospective Analysis

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3591-3591
Author(s):  
Jacoline E.C. Bromberg ◽  
Jeanette Doorduyn ◽  
Macha Schuurmans ◽  
Philip Poortmans ◽  
Martin J.B. Taphoorn ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Performance Status ◽  
Primary Cns Lymphoma ◽  
The Elderly ◽  
Cns Lymphoma ◽  
Combined Modality Treatment ◽  
Significant Prognostic Factor ◽  
Adequate Treatment ◽  
Increased Risk

Abstract Patients with primary CNS lymphoma (PCNSL) are preferably treated with high-dose Methotrexate (HD-MTX)-based chemotherapy followed by consolidation radiotherapy in many centers. As elderly patients have an increased risk of complications with this approach, they are frequently treated with chemotherapy or radiotherapy alone. Little is known about the efficacy and toxicity of either of these treatments in elderly patients outside clinical studies. We analysed all patients aged 60 or above referred with PCNSL to 5 Dutch centers between 1998 and 2007. 110 patients were identified. We excluded: patients who were not treated because of a poor condition (n=25), patients with EBVrelated NHL (n=3), patients with PCNSL confined to the eyes (n=3), and patients with missing information on follow-up (n=5). The remaining 74 patients had a median age of 65 years (range 60–82), and a median KPS of 70% (range 30–100). Twenty-nine of them were treated with radiotherapy only, 19 with chemotherapy only and 26 with both; 19 of these 26 received radiotherapy after failure of chemotherapy. Median KPS was 70 in both single treatment modality groups and 80 in the group receiving both modalities. The response rate (CR or PR) was 69% (20/29) in patients treated with radiotherapy only and 63% (12/19) in patients treated with chemotherapy only. Timing of both response evaluation and radiotherapy after chemotherapy were highly variable in the group treated with both modalities, therefore these patients are only included in the overall survival analyses. Median overall survival (OS) was 20 months: 7 months for patients treated with radiotherapy only, 23 months for those treated with chemotherapy only, and 31 months for combined modality treatment (p=0.01). The KPS was a significant prognostic factor for as well PFS as OS (p<0.001): median PFS and OS were 3 and 4 months respectively in patients with KPS < 70 and 18 and 25 months in patients with a KPS ≥ 70. Forty of the 45 patients receiving chemotherapy were planned for treatment with a MTX dose of 3g/m2. There were 2 toxic deaths. Ten of the 40 patients received delayed or reduced doses, or aborted chemotherapy because of toxicity. Delayed encephalopathy was reported in 15 patients: 7/30 patients after radiotherapy, 1/19 after chemotherapy only and 7/26 after combined treatment. Five died as a consequence of the encephalopathy. Conclusion: Performance status is the most important single variable determining prognosis in elderly patients. Overall survival after HD-MTX-based treatment for PCNSL in the elderly appears to approach survival obtained in younger patients, provided the performance status is adequate. Treatment related mortality of HD-MTX-based chemotherapy seems not to be increased in older patients.

Importance of Radiotherapy in the Outcome of Patients With Primary CNS Lymphoma: An Analysis of the CHOD/BVAM Regimen Followed by Two Different Radiotherapy Treatments

2002 ◽  
Vol 20 (1) ◽  
pp. 231-236 ◽  
Author(s):  
E. M. Bessell ◽  
A. López-Guillermo ◽  
S. Villá ◽  
E. Verger ◽  
B. Nomdedeu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Performance Status ◽  
Primary Cns Lymphoma ◽  
Complete Response ◽  
Cns Lymphoma ◽  
Reduced Dose ◽  
Increased Risk ◽  
Risk Of Relapse ◽  
All Treatment

PURPOSE: To assess the effect of a reduced dose of radiotherapy (RT) in patients with primary CNS lymphoma (PCNSL) responding to the cyclophosphamide, doxorubicin, vincristine, and dexamethasone (CHOD)/carmustine, vincristine, methotrexate, and cytarabine (BVAM) regimen. PATIENTS AND METHODS: Patients received one cycle of CHOD and two of BVAM. In the first trial, all 31 patients received 45-Gy whole-brain RT (CHOD/BVAM I). In the second, with 26 patients, RT dose was reduced to 30.6 Gy if there was a complete response (CR) after chemotherapy (CHOD/BVAM II). RESULTS: Age, performance status, and chemotherapy received were similar in both protocols. CR rate at the end of all treatment was 68% for CHOD/BVAM I and 77% and for CHOD/BVAM II. Treatment modality was the only predictor of relapse, with 3-year relapse risks of 29% and 70% for CHOD/BVAM I and II, respectively. This was specifically important in the 25 patients less than 60 years old (3-year relapse risk, 25% v 83%; P = .01). The 5-year overall survival (OS) was 36%. Age (< 60 v ≥ 60 years) was the only predictor for OS in the multivariate analysis (relative risk, 2.1; 95% confidence interval, 1.4 to 2.8). RT dose was the only predictor of OS in patients younger than 60 years old who achieved CR at the end of all treatment (3-year OS, 92% v 60% for patients receiving 45 or 30.6 Gy, respectively; P = .04). CONCLUSION: Reduction of the RT dose from 45 Gy to 30.6 Gy in patients younger than 60 years old with PCNSL who achieved CR resulted in an increased risk of relapse and lower OS.

Elderly Patients with Early-Unfavorable Stage Hodgkin’s Disease (HD) Have a Poorer Outcome When Treated with Combined Modality Treatment and Extended Field Radiotherapy (EF): A Retrospective Analysis of the German Hodgkin Study Group.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1305-1305
Author(s):  
Andreas Engert ◽  
Heinz Haverkamp ◽  
Hans T. Eich ◽  
Andreas Josting ◽  
Beate Pfistner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
The Elderly ◽  
Combined Modality Treatment ◽  
Study Group ◽  
Younger Patients ◽  
German Hodgkin Study Group ◽  
Mediastinal Tumours ◽  
Extended Field ◽  
Involved Field

Abstract Purpose: The HD8 study of the German Hodgkin Study Group (GHSG) demonstrated that involved field (IF) radiotherapy is equally effective when compared with EF radiotherapy after four cycles of chemotherapy (2 x COPP/ABVD). Since there are indications that elderly patients with HD might fare worse depending on the type of treatment applied, we revisited the HD8 data for possible differences between younger and older patients. Methods and results: A total of 1204 patients were randomised to receive two double cycles of COPP/ABVD and either 30 Gy EF + 10 Gy bulk or 30 Gy IF + 10 Gy bulk. Of these, 98 evaluable patients were older than 60 years and 1038 patients were younger than 60 years. In general, there were more risk factors such as B-symptoms, elevated ESR, and poorer Karnofski index in the elderly group. On the other hand, there were fewer bulky tumours, large mediastinal tumours and a lower number of lymph node areas involved in elderly patients. The toxicity of treatment was more pronounced in elderly patients with 76 of 96 patients experiencing chemotoxicity Grade III or IV (79%) compared with 699 of 1018 (69%) in those younger than 60 years. After a median follow up of 52 months, the 5-year-FFTF was 85% in younger patients and 63% in patients older than 60 years (p &lt;0.001). The 5-year-overall survival was 94% for patients younger than 60 years and 66% for patients older than 60 years (p &lt; 0.001). In addition, patients older than 60 years treated with EF had a trend for worse FFTF and overall survival compared to those receiving IF radiotherapy. Conclusion: Event-free and overall survival of patients older than 60 years old are worse compared with younger patients. In particular, patients older than 60 years receiving EF radiotherapy had a poorer prognosis.

Primary intraocular lymphoma (PIOL): An International Primary CNS Lymphoma Collaborative group report

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1534-1534
Author(s):  
S. Grimm ◽  
J. Pulido ◽  
K. Jahnke ◽  
D. Schiff ◽  
A. Hall ◽  
...  
Keyword(s):  
Performance Status ◽  
Primary Cns Lymphoma ◽  
Local Therapy ◽  
Initial Therapy ◽  
Collaborative Group ◽  
Intraocular Lymphoma ◽  
Cns Lymphoma ◽  
Treatment Type ◽  
Increased Risk ◽  
Sites Of Relapse

1534 Background: PIOL is a hemopoietic tumor that arises in the retina, vitreous or optic nerve head, and carries a high risk of ocular and CNS relapse. The natural history and optimal management are unknown. Methods: A retrospective series of 81 patients with PIOL was assembled from 15 centers in 7 countries. Only patients with isolated ocular lymphoma were included; none had brain, spinal cord, or systemic lymphoma at diagnosis. Results: The median age at diagnosis was 65 (24–85). 58% were women. The median ECOG performance status was 0, and only three had a score > 1. The median latency from symptom onset to diagnosis was 6 months (0– 36). Slit lamp exam was positive in 51, negative in 6, and not reported in 24. Vitrectomy was positive in 72 and negative in 2. 6 had a positive choroidal or retinal biopsy and 1 had no ocular surgery. CSF cytology was positive in 10 (17%), negative in 48, and unknown in 23. 21 received local therapy at diagnosis: 6 intra-ocular methotrexate (400 ug), 14 ocular radiation (median 3600 cGy), and 1 both modalities. 52 received more extensive therapy including systemic chemotherapy alone in 20 and a combination of chemotherapy and radiotherapy in 32. 5 received no treatment and details are unknown in 3. 47 patients (58%) relapsed a median of 19 months (0.5–180) after initial therapy. Sites of relapse included brain 47%, eyes 30%, brain and eyes 15%, and systemic 8%. Patients treated with ocular therapy alone did not have an increased risk of failing in the brain (p = 0.6). Progression free survival (PFS) and overall survival (OS) were 29.6 and 57 months respectively and were unaffected by the choice of therapy. CNS disease was the cause of death in 19/33 (58%). Conclusions: In this series, treatment type did not affect sites of relapse, PFS or OS in patients with PIOL. To minimize toxicity, the best initial therapy should be limited to intraocular chemotherapy or focal radiotherapy. Prospective clinical trials are needed to improve our understanding and treatment of this disease. No significant financial relationships to disclose.

Patterns of Treatment and Survival in Elderly Patients with Primary CNS Lymphoma; An 11-Year Population-Based Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 2-3
Author(s):  
Yazan Samhouri ◽  
Moaath Mustafa Ali ◽  
Thejus Jayakrishnan ◽  
Chelsea Peterson ◽  
Veli Bakalov ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
Primary Cns Lymphoma ◽  
The Elderly ◽  
Population Based ◽  
Rank Test ◽  
Cns Lymphoma ◽  
Younger Patients ◽  
To Receive ◽  
Wilcoxon Rank Test

Introduction Primary CNS lymphoma (PCNSL) is an aggressive form of lymphoid malignancy that occurs exclusively in the brain, meninges, spinal cord, and eyes. The incidence of PCNSL has been increasing, particularly in the elderly population, with a median age at diagnosis of 66 years (Olson J.E. et al., Cancer 2002). The primary modality of treatment for this deadly disease is systemic chemotherapy that includes high-dose methotrexate (HD-MTX), with or without whole-brain radiation. Due to the toxicity of HD-MTX, physicians tend to avoid using it in the elderly population. This was confirmed in previous reports from the 1990s (Panageas K.S. et al., Cancer 2007). In this comprehensive population-based analysis, we sought to examine the patterns of treatment and survival in elderly patients in the 2000s and sought to investigate clinical and socioeconomic predictors of treatment selection. Methods We conducted a retrospective cohort analysis using de-identified data accessed from the national cancer database (NCDB). The NCDB provided records of 2985 patients diagnosed with PCNSL between 2004 and 2015. We excluded patients who are younger than 65 years old, those who tested positive for HIV, and those who started treatment &gt;120 days since diagnosis to account for immortal time bias. Patients were divided into four groups based on treatment received: combined modality treatment (CMT), chemotherapy alone, radiation alone, and no treatment. Exploratory analysis of the patient groups was performed. Summary statistics are presented as percentages for categorical data and median with interquartile range for quantitative data. Multivariate regression models were used to analyze predictors of the selection of any treatment versus no treatment and for selecting chemotherapy versus no chemotherapy. To account for variable baseline characteristics, we used propensity score weighting methodology to calculate estimates of interest. Survival estimates were performed using the Kaplan-Meier method, and survival differences were tested using the wilcoxon-rank test. Results We identified 1096 patients with PCNSL who fulfilled the inclusion criteria. The median age was 73 (IQR: 68-79). There were 52% males. The majority of the patients were whites (92%), lived in a metropolitan area (78%), treated at an academic/research center (57%). The most common treatment modality used was chemotherapy alone (48%), followed by CMT (22%), no treatment (16%), and radiation alone (13%). On multivariate analysis, age (OR: 0.94, 95% CI 0.92-0.96) and comorbidity score (OR: 0.63, 95% CI 0.52-0.76) significantly predicted receiving any type of treatment. Both age (OR: 0.91, 95% CI 0.89-0.94) and distance (OR: 1.006, 95% CI 1.001-1.01) were predictors of receiving chemotherapy. Median follow up was 12 months (IQR: 3-44). Median OS in months for the four groups was: 43.1 for CMT, 19.4 for chemotherapy alone, 17.2 for radiation alone, and 2.3 for no treatment. (wilcoxon-rank test p-value: &lt;0.001). Median OS for the whole population was 17 months (IQR: 12-26). Patients &gt;75 year old had lower median OS in general, but receiving CMT had a survival advantage as well. (Figures 1 and 2) Conclusions The majority of PCNSL patients in our analysis received treatment. Our results showed an increased trend of chemotherapy use in elderly patients compared with earlier reports, where radiation alone was the most common treatment modality. The median OS of patients was longer compared with the 1990s data (17 vs. 7 months). CMT was associated with better OS compared with no treatment and chemotherapy alone. Although this was numerically better compared with radiation alone, it was not statistically significant. Younger patients and patients with lower comorbidity scores were more likely to receive treatment. Younger patients and patients who live further from the treating facility were more likely to receive chemotherapy. Longer distance may have led to less radiation use due to the need for complex planning and frequent visits associated with radiation therapy. Our study is limited by its retrospective nature, which makes it at risk of selection bias. Using propensity score weighting methodology strengthens our results. Also, the NCDB lacks certain pertinent variables, such as details of chemotherapy regimens, and toxicity information especially for radiation in the CMT arm which will have practical implications. Disclosures Fazal: Glaxosmith Kline: Consultancy, Speakers Bureau; Incyte Corporation: Consultancy, Honoraria, Speakers Bureau; Karyopham: Speakers Bureau; Celgene: Speakers Bureau; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jansen: Speakers Bureau; Stemline: Consultancy, Speakers Bureau; Gilead/Kite: Consultancy, Speakers Bureau; Agios: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Jazz Pharma: Consultancy, Speakers Bureau. Kahn:Genetech: Honoraria; Takeda: Honoraria; Karyopharm: Honoraria; Seattle Genetics: Honoraria; Abbvie: Honoraria; Celgene: Honoraria; AstraZeneca: Honoraria; Beigene: Honoraria.

Treatment of Primary CNS Lymphoma with Induction High-Dose Methotrexate, Temozolomide, Rituximab Followed by Consolidation Cytarabine/Etoposide: A Pilot Study with Biomarker Analysis.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1364-1364 ◽  
Author(s):  
Samar Issa ◽  
Arthur Shen ◽  
Jon Karch ◽  
Cigall Kadoch ◽  
Marc Shuman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Performance Status ◽  
Primary Cns Lymphoma ◽  
Immunohistochemical Analysis ◽  
Cns Lymphoma ◽  
High Dose ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Brain Irradiation ◽  
Biomarker Analysis

Abstract Background: There is no consensus on the optimal treatment for patients diagnosed with primary CNS lymphoma (PCNSL). The goals of this study were: to determine the safety and efficacy of a methotrexate (MTX)-based induction therapy followed by high-dose consolidation chemotherapy and the elimination or deferral of whole brain irradiation, to identify molecular markers in PCNSL which predict sensitivity to chemotherapy and outcome. Methods: 23 newly diagnosed, CD20-positive, immunocompetent PCNSL patients were treated with combination high-dose intravenous MTX (8 gm/m2), temozolomide (150 mg/m2/day) and intravenous rituximab (375 mg/m2) (MTR). Patients in complete remission (CR) after eight courses of MTX were offered consolidation with high-dose cytarabine (2 g/m2 x 8 doses) and etoposide (40 mg/kg over 96 hours) (AE). Candidate markers of outcome in PCNSL were identified by gene expression profile analysis of an independent, multicenter dataset of PCNSL tumors. Immunohistochemical analysis of one of these markers, death-associated protein-1 (DAP-1), was performed on paraffin sections of tumors from 18 of the patients treated with the MTR regimen. Results: MTR induction followed by AE consolidation was well tolerated with no treatment-related mortality or evidence for neurotoxicity. Thirteen patients (56.5%) attained CR with induction; 8 received consolidation; 5 in CR refused AE. Median progression-free (PFS) and overall survival (OS) has not yet been reached with a median follow-up of 33 months. Karnovsky performance status (KPS) correlated with improved survival (p<0.0281). Expression by lymphoma cells of DAP-1, a regulator of apoptosis, was associated with improved progression-free survival (p<0.03) and overall survival (p<0.038). Conclusions: Combination MTR followed by AE is well tolerated in PCNSL. PFS appears at least similar to regimens that contain whole brain irradiation. A multi-center study has been initiated to further evaluate this regimen. DAP-1 may be a tumor suppressor whose expression in PCNSL predicts a favorable response to MTX-based therapy.

scholarly journals The Trend of Combined Modality Treatment and its Outcomes in Elderly Patients With Primary CNS Lymphoma; A 12-Year Population-Based Analysis Using Propensity Score

2021 ◽  
Author(s):  
Yazan Samhouri ◽  
Moaath K Mustafa Ali ◽  
Thejus Jayakrishnan ◽  
Veli Bakalov ◽  
Salman Fazal ◽  
...  
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Primary Cns Lymphoma ◽  
Population Based ◽  
Treatment Selection ◽  
Cns Lymphoma ◽  
P Value ◽  
Combined Modality Treatment ◽  
Factors Affecting ◽  
Combined Modality

Abstract BackgroundThe addition of radiation to chemotherapy in elderly patients with PCNSL remains controversial. Our objective was to assess the trend of combined modality treatment (CMT) and compare its survival with chemotherapy alone and radiation alone in non-HIV patients. MethodsWe identified 6,537 patients who received single treatment modality, combined modality treatment, or no treatment at all between 2004 and 2015 from the National Cancer Database. Factors affecting treatment selection were investigated using a logistic regression model. Annual percentage change (APC) was calculated to assess the trend of CMT use. A propensity score weighting methodology was used to compare survival outcomes. FindingsOnly 12.8% of patients received CMT, and this proportion steadily declined between 2004 (17.7%) and 2015 (8.7%), with APC of -6.0% (95% CI -8.0 to -4.0, p-value <0.001) during the 12 years. Apart from classical prognostic factors (age and comorbidities), treatment selection was significantly influenced by sex, facility type, degree of urbanization, and type of insurance. CMT had improved survival (median overall survival 19.5 months (95% CI 15.7-22.8)) compared with single-modality treatment. This effect was more prominent in the first year. Conclusion Socioeconomic factors affect the selection of treatment in elderly patients with PCNSL that can alter outcomes. CMT is falling out of favor in this patient population due to the risks of neurotoxicity. Further work should focus on developing strategies that minimize toxicity and access disparities without compromising survival

Prognostic model for primary CNS lymphoma (PCNSL): Recursive partitioning analysis (RPA) of the MSKCC PCNSL population

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1531-1531 ◽  
Author(s):  
L. E. Abrey ◽  
L. Benporat ◽  
K. S. Panageas ◽  
J. Yahalom ◽  
L. M. Deangelis
Keyword(s):  
Overall Survival ◽  
Prognostic Model ◽  
Proportional Hazards ◽  
Prognostic Score ◽  
Performance Status ◽  
Univariate Analysis ◽  
Primary Cns Lymphoma ◽  
Cox Proportional Hazards ◽  
Cns Lymphoma ◽  
Analysis And Design

1531 Background: Increasingly there is a need to develop a simple prognostic score that can be used in the analysis and design of PCNSL studies as well as for clinical management. Recently the IELSG published a 3 group prognostic model incorporating patient age, performance status, serum LDH, location of brain lesions and CSF total protein; however, only 105 of their 378 patients had all of the variables available to develop this score. Methods: We analyzed 338 patients (median age 60; median KPS 70) seen and treated for PCNSL at MSKCC between 1983 and 2003. The median survival was 37 months and median follow up of surviving patients is 35 months. Univariate analysis of potential prognostic factors was performed using the Kaplan Meier product limit method. Significant univariate variables were included in a multivariate analysis using the Cox proportional hazards regression model. Patients were separately analyzed using the IELSG prognostic score. Finally, RPA was employed as an independent method of developing specific prognostic categories. Results: In the univariate analysis, age, hemiparesis, mental status changes, creatinine clearance and KPS were significant predictors of overall survival; in the multivariate model only age and KPS remained as significant predictors. 113 patients had adequate information (all 5 variables) to be analyzed using the IELSG prognostic score; while this correlated significantly with overall survival, the comparison between groups 2 and 3 was not statistically significant (p = 0.10). RPA of all 338 patients identified 3 subgroups: age ≤ 50 (median OS 9.2 y), age > 50 and KPS ≥ 70 (median OS 3.2 y) and age > 50 and KPS < 70 (median OS 1 y) that significantly separated our entire PCNSL population (p < 0.001). Conclusions: The use of RPA allows for easy discrimination of 3 prognostic groups of patients with PCNSL. In contrast to the IELSG score the MSK RPA classification includes information that is readily available on all patients and can be easily incorporated into the analysis or design of clinical research. No significant financial relationships to disclose.

Elderly patients with primary CNS lymphoma: Results from the G-PCNSL-SG-1 trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2007-2007
Author(s):  
Patrick Roth ◽  
Peter Martus ◽  
Philipp M. Kiewe ◽  
Robert Moehle ◽  
Hermann A. Klasen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Salvage Therapy ◽  
Primary Cns Lymphoma ◽  
Central Nervous System Lymphoma ◽  
The Elderly ◽  
Response To Therapy ◽  
Cns Lymphoma ◽  
High Dose ◽  
Younger Patients ◽  
The Impact

2007 Background: Age is the most important therapy-independent prognostic factor in patients with primary central nervous system lymphoma (PCNSL). Here we aimed at providing an analysis of the impact of higher age on response to therapy, toxicity, and survival in the largest PCNSL trial ever performed to date. Methods: Response to therapy, toxicity and survival of PCNSL patients enrolled in the G-PCNSL-SG-1 trial evaluating the role of radiotherapy after high-dose methotrexate (HD-MTX)-based chemotherapy were monitored. Subjects aged 70 or more were compared to younger patients. Results: Of all eligible patients (n=526), 126 (24%) were aged 70 or more. In the per protocol population, 66 of 318 patients (21%) were at least 70 years old. Among the eligible patients, the rate of complete and partial responses (CR+PR) to HD-MTX-based chemotherapy was 44% in the elderly compared to 57% in the younger patients (p=0.016). A higher rate of grade III/IV leukopenia was observed in the elderly (34% versus 21%, p=0.007). Also, death on therapy was more frequent (18% versus 11%; p=0.027) in these patients. In contrast, there was no other major age-dependent toxicity. Survival analyses revealed shorter progression-free survival (PFS) (4.0 versus 7.7 months, p=0.014) and overall survival (OS) (12.5 versus 26.2 months, p<0.001) in the elderly population. The PFS of CR patients was 35.0 months in younger patients compared to 16.1 in the elderly (p=0.024). Salvage therapy was used less commonly in elderly patients. When salvage WBRT was applied in patients who had failed on HD-MTX-based chemotherapy, there was no association between age and survival (p=0.633). Conclusions: Elderly PCNSL patients have a lower response rate and higher mortality on HD-MTX-based chemotherapy. Their PFS is shorter and they receive less salvage therapy which may contribute to the poor prognosis.

First-line temozolomide therapy and MGMT status in elderly patients with primary CNS lymphoma

2009 ◽  
Vol 36 (S 02) ◽  
Author(s):  
M Glas ◽  
D Kurzwelly ◽  
P Roth ◽  
K Rasch ◽  
E Weimann ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Primary Cns Lymphoma ◽  
Cns Lymphoma ◽  
First Line

scholarly journals Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yongfei He ◽  
Tianyi Liang ◽  
Shutian Mo ◽  
Zijun Chen ◽  
Shuqi Zhao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Cancer ◽  
Elderly Patients ◽  
Surgical Resection ◽  
Influencing Factors ◽  
The Elderly ◽  
Primary Hepatocellular Carcinoma ◽  
Surgical Timing ◽  
Duration Of Surgery

Abstract Background The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients. Methods A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed. Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival. Conclusions We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

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