Bilateral radiation therapy followed by methotrexate-based chemotherapy for primary vitreoretinal lymphoma

Macarena I De La Fuente, Juan Pablo Alderuccio, Isildinha Reis, Antonio Omuro, Arnold Markoe, Jose J. Echegaray, Janet L Davis, J. William Harbour, Izidore Lossos

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Abstract

Primary vitreoretinal lymphoma (PVRL) is a subset of primary CNS lymphoma that presents as isolated ocular disease without brain involvement. Although ocular radiotherapy (RT) is an effective treatment for PVRL, the optimal treatment is uncertain. PVRL may later involve the brain in 56%-85% of patients. We report on 12 PVRL patients treated with a combination of bilateral RT and a systemic chemotherapy (CT) regimen containing high-dose methotrexate (M). Ten received RT (30-40 Gy) followed by CT, one received RT, and one was treated with intravitreal M; all achieved a complete response (CR). Three patients had tumor recurrence in the brain and received CT and one patient relapsed in the eye with a second recurrence in the brain. Three patients achieved CR-2 remain alive and one died of dementia. One died from recurrent CNS disease. With a median follow of 68 months (range, 17-154 months), median progression-free and overall survival have not been reached. Bilateral RT followed by M-based CT is an effective treatment for reducing CNS progression and prolonging survival.

Original languageEnglish (US)
JournalAmerican Journal of Hematology
DOIs
StatePublished - Jan 1 2019

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Methotrexate
Lymphoma
Radiotherapy
Drug Therapy
Brain
Recurrence
Eye Diseases
Central Nervous System Diseases
Disease-Free Survival
Dementia
Therapeutics
Survival
Neoplasms

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Bilateral radiation therapy followed by methotrexate-based chemotherapy for primary vitreoretinal lymphoma",
abstract = "Primary vitreoretinal lymphoma (PVRL) is a subset of primary CNS lymphoma that presents as isolated ocular disease without brain involvement. Although ocular radiotherapy (RT) is an effective treatment for PVRL, the optimal treatment is uncertain. PVRL may later involve the brain in 56{\%}-85{\%} of patients. We report on 12 PVRL patients treated with a combination of bilateral RT and a systemic chemotherapy (CT) regimen containing high-dose methotrexate (M). Ten received RT (30-40 Gy) followed by CT, one received RT, and one was treated with intravitreal M; all achieved a complete response (CR). Three patients had tumor recurrence in the brain and received CT and one patient relapsed in the eye with a second recurrence in the brain. Three patients achieved CR-2 remain alive and one died of dementia. One died from recurrent CNS disease. With a median follow of 68 months (range, 17-154 months), median progression-free and overall survival have not been reached. Bilateral RT followed by M-based CT is an effective treatment for reducing CNS progression and prolonging survival.",
author = "{De La Fuente}, {Macarena I} and Alderuccio, {Juan Pablo} and Isildinha Reis and Antonio Omuro and Arnold Markoe and Echegaray, {Jose J.} and Davis, {Janet L} and {William Harbour}, J. and Izidore Lossos",
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T1 - Bilateral radiation therapy followed by methotrexate-based chemotherapy for primary vitreoretinal lymphoma

AU - De La Fuente, Macarena I

AU - Alderuccio, Juan Pablo

AU - Reis, Isildinha

AU - Omuro, Antonio

AU - Markoe, Arnold

AU - Echegaray, Jose J.

AU - Davis, Janet L

AU - William Harbour, J.

AU - Lossos, Izidore

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Primary vitreoretinal lymphoma (PVRL) is a subset of primary CNS lymphoma that presents as isolated ocular disease without brain involvement. Although ocular radiotherapy (RT) is an effective treatment for PVRL, the optimal treatment is uncertain. PVRL may later involve the brain in 56%-85% of patients. We report on 12 PVRL patients treated with a combination of bilateral RT and a systemic chemotherapy (CT) regimen containing high-dose methotrexate (M). Ten received RT (30-40 Gy) followed by CT, one received RT, and one was treated with intravitreal M; all achieved a complete response (CR). Three patients had tumor recurrence in the brain and received CT and one patient relapsed in the eye with a second recurrence in the brain. Three patients achieved CR-2 remain alive and one died of dementia. One died from recurrent CNS disease. With a median follow of 68 months (range, 17-154 months), median progression-free and overall survival have not been reached. Bilateral RT followed by M-based CT is an effective treatment for reducing CNS progression and prolonging survival.

AB - Primary vitreoretinal lymphoma (PVRL) is a subset of primary CNS lymphoma that presents as isolated ocular disease without brain involvement. Although ocular radiotherapy (RT) is an effective treatment for PVRL, the optimal treatment is uncertain. PVRL may later involve the brain in 56%-85% of patients. We report on 12 PVRL patients treated with a combination of bilateral RT and a systemic chemotherapy (CT) regimen containing high-dose methotrexate (M). Ten received RT (30-40 Gy) followed by CT, one received RT, and one was treated with intravitreal M; all achieved a complete response (CR). Three patients had tumor recurrence in the brain and received CT and one patient relapsed in the eye with a second recurrence in the brain. Three patients achieved CR-2 remain alive and one died of dementia. One died from recurrent CNS disease. With a median follow of 68 months (range, 17-154 months), median progression-free and overall survival have not been reached. Bilateral RT followed by M-based CT is an effective treatment for reducing CNS progression and prolonging survival.

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