Radiation Therapy and High-Dose Corticosteroids in Treating Older Patients With Primary CNS Non-Hodgkin's Lymphoma

Radiation Therapy and High-Dose Corticosteroids in Treating Older Patients With Primary CNS Non-Hodgkin's Lymphoma

Primary Central Nervous System Non-Hodgkins's Lymphoma (PCNSL): A Phase II Clinical Trial of Radiation Therapy and High Dose Corticosteroids for Elderly Patients (70 Years of Age and Older)

RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Combining radiation therapy with a corticosteroid, such as dexamethasone, may be an effective treatment for non-Hodgkin's lymphoma. PURPOSE: Phase II trial to study the effectiveness of radiation therapy and high-dose dexamethasone in treating older patients with primary CNS non-Hodgkin's lymphoma.

OBJECTIVES: Assess the effectiveness of high-dose dexamethasone after whole-brain radiotherapy in maintaining response and preventing recurrence in elderly patients with primary central nervous system non-Hodgkin's lymphoma. Assess the toxic effects of this regimen in these patients. Assess the survival rate of patients after this regimen. Identify the anatomic rates of recurrence and frequency of systemic involvement in patients treated with this regimen. Identify the factors that appear to be associated with outcome in patients treated with this regimen. OUTLINE: Patients undergo whole-brain radiotherapy (WBRT) daily 5 days a week for 4.5 weeks. Beginning 30 days after WBRT is completed, patients receive high-dose dexamethasone IV on days 1-5 during course 1 and on day 1 only during all subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients are followed at 1 month after radiotherapy, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 28 patients will be accrued for this study within 6 years.

Patients undergo whole-brain radiotherapy (WBRT) daily 5 days a week for 4.5 weeks. Beginning 30 days after WBRT is completed, patients receive high-dose dexamethasone IV on days 1-5 during course 1 and on day 1 only during all subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients are followed at 1 month after radiotherapy, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

DISEASE CHARACTERISTICS: Pathologically confirmed non-Hodgkin's lymphoma with intracranial lesions Intraocular lymphoma eligible, if not sole site of disease No occult systemic lymphoma Measurable or evaluable disease by CT scan or MRI No neoplastic meningitis or gross spinal cord involvement PATIENT CHARACTERISTICS: Age: 70 and over Performance status: ECOG 0-3 Other: No prior history of lymphoma No other active malignancy except basal cell skin cancer or carcinoma in situ of the cervix HIV negative No active peptic ulcer disease No uncontrolled diabetes mellitus No active pancreatitis No active bleeding No poorly controlled major psychiatric illness No serious uncontrolled infection PRIOR CONCURRENT THERAPY: Biologic therapy: No prior bone marrow transplantation Chemotherapy: No prior chemotherapy Radiotherapy: No prior radiotherapy to the brain or head and neck region Surgery: No prior transplantations (renal, hepatic, or cardiac)

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