Abstract
BACKGROUND: Primary and secondary central nervous system lymphoma (PCNSL, SCNSL) are typically treated with chemotherapy and external beam radiation therapy (EBRT). There is no standard salvage therapy for either. The role of stereotactic radiosurgery (SRS) as salvage therapy in PCNSL and SCNSL is poorly defined. METHODS: A retrospective analysis was performed of all patients having SRS, typically using the Gamma Knife (GK), for recurrent intracranial PCNSL and SCNSL at Mayo Clinic Rochester between 2004 and 2011. RESULTS: Fourteen patients underwent SRS. All had their SRS via the GK. The median patient age was 71 years. Seven patients (50%) had PCNSL and seven patients had SCNSL. All had received prior chemotherapy and 10 patients (71%) had undergone prior EBRT with a median dose of 40 Gy in 25 fractions. The median tumor volume was 6.7 cm3 (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 288 days, 472 days for PCNSL and 288 days for SCNSL. Significant factors contributing to survival greater 9 months following SRS, were increased marginal dose (Odds ratio = 7.8, p = 0.006, 95% CI (1.74-188.79), increase in maximal dose (Odds ratio = 1.54, p = 0.008, 95% CI (1.09-2.77), and increase in pre-treatment Karnofsky score (Odds ratio = 4.69, p = 0.001, 95% CI (1.45-75.5). No patient had a major radiation-related complication. CONCLUSION: SRS for patients with recurrent CNS lymphoma is well-tolerated and has a high rate of radiographic response. Survival after SRS varied based on multiple factors including marginal and maximal radiation dose and pretreatment Karnofsky score. Control of microscopic disease using established therapies remains vitally important and is not addressed with SRS. SRS represents a viable therapy for local control of recurrent CNS lymphoma for properly selected patients.
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