Long-term remission of XXXX by intensified methotrexate chemotherapy.

@entity1 @entity66 @entity5 @entity149 @entity1500 @entity1499 @entity2359
High-dose (1-3.5 g/m2) @entity1499 ( @entity1500 ) followed by whole-brain radiation therapy (WBRT) has consistently improved length of survival in @entity149 ( @entity149 ), but the prognosis remains dismal. To optimize and enhance the dose intensity of @entity1500 , we applied @entity1500 at 8 g/m2 to 20 @entity1 with @entity149 . In an effort to lower the risk of @entity2359 treatment sequelae, the WBRT dose was reduced to 30 Gy in cases of complete remission after @entity1500 therapy. Further, omission of WBRT and administration of stereotactic radiotherapy (SRT) were undertaken in 3 older @entity1 . The overall response rate to the @entity1500 therapy was 83%. The median progression free survival (PFS) was 54 months with a median overall survival (OS) of 57 months. Achieving a complete response after @entity1500 therapy was significantly associated with a longer PFS. Late @entity2359 was encountered in 4 (50%) of 8 @entity1 who were aged 60 years or older and received WBRT, but in none of 12 @entity1 who were aged less than 60 years or avoided WBRT. All older @entity1 who underwent SRT sustained complete remission without a @entity66 . Intensifying the @entity1500 dosage to 8 g/m2 appears more promising in comparison to results reported with @entity1500 doses of 1-3.5 g/m2. In younger @entity1 , the establishment of complete remission by intensified @entity1500 therapy and subsequent WBRT with a relatively lower dose could promise durable @entity5 remission with an acceptable @entity2359 . In older @entity1 , WBRT should be avoided to sustain a meaningful survival, and SRT may provide a valid strategy in terms of enhancing @entity66 control without undue risk.
