P11.07BLOOD-BRAIN BARRIER DISRUPTION AND INTRA-ARTERIAL METHOTREXATE-BASED THERAPY FOR NEWLY DIAGNOSED PRIMARY CNS LYMPHOMA: A SINGLE-INSTITUTION EXPERIENCE

摘要

INTRODUCTION: Primary CNS lymphoma (PCNSL) is confined to the CNS and/or the eyes at presentation and is usually initially treated with intravenous methotrexate-based chemotherapy and whole-brain radiotherapy (WBRT). However, the intact blood-brain barrier (BBB) can limit diffusion of methotrexate into brain and tumor and so very high doses of methotrexate are needed for intravenous treatment. With BBB disruption (BBBD), enhanced drug delivery to the tumor can be achieved. Both methods are well known and are using in different clinics in the World. PATIENTS AND METHODS: This report summarizes the single institutional (Burdenko Neurosurgical Institute, Moscow, Russia) experience of 104 newly diagnosed patients with PCNSL treated with osmotic BBBD and intra-arterial (IA) methotrexate from 2000 to 2013. There were 57 female and 47 male at age from 25 to 75 (median 57,6 and 40,1% > or = 60). 51.3% had Karnofsky performance score (KPS) less than 70 at diagnosis. Diagnosis was verified by stereotactic biopsy (STB) in 76,7 % of cases and by tumor removing in 21,1% and by open biopsy in 2,2%. RESULTS: The overall response rate was 86.4% (63.8% complete; 21.6% partial). Median overall survival (OS) was 35 months. Median progression-free survival (PFS) was 24 months, with 5-year PFS of 29,4%. In 20 of 104 patients ophthalmological signs of intraocular lymphoma were registered (19.2%). Procedures were generally well tolerated and there were no cases of technique associated deaths in our series. CONCLUSION: Our results of treating large series of PCNSL patients using BBBD/IA methotrexate-based chemotherapy confirmed successful and durable tumor control and outcomes that were reported early. BBBD/IA technique are comparable to other PCNSL treatment regimens.