TY - JOUR
T1 - Response-adapted radiation therapy for newly diagnosed primary diffuse large B-cell lymphoma of the CNS treated with methotrexate-based systemic therapy
AU - Sheu, Tommy
AU - Milgrom, Sarah A.
AU - Andraos, Therese Y.
AU - Gunther, Jillian R.
AU - Chi, Linda
AU - Nastoupil, Loretta
AU - Fowler, Nathan
AU - Oki, Yasuhiro
AU - Fanale, Michelle A.
AU - Fayad, Luis E.
AU - Hagemeister, Fredrick
AU - Neelapu, Sattva S.
AU - Medeiros, L. Jeffrey
AU - Hosing, Chitra
AU - Nieto, Yago
AU - Ahmed, Sairah
AU - Alousi, Amin M.
AU - Dabaja, Bouthaina
AU - Pinnix, Chelsea C.
N1 - Publisher Copyright:
© 2018 The Authors on behalf of the American Society for Radiation Oncology
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: For patients with primary diffuse large B-cell lymphoma of the central nervous system (PCNSL), whole-brain radiation therapy (WBRT) to doses of ≥45 Gy are often given after a partial response (PR) to methotrexate-based induction chemotherapy. We conducted an exploratory analysis to determine whether lower-dose WBRT, given with a boost to sites of persistent disease, might be a reasonable alternative. Methods and materials: We retrospectively reviewed the records of 22 patients with PCNSL who received WBRT, with or without a boost, after methotrexate-based induction chemotherapy. Outcomes were compared among patients according to response to chemotherapy using the Kaplan-Meier method. Results: Median follow-up was 52 months. All patients with a complete response (CR) (n = 5) received WBRT to 23.4 Gy. One CR patient died after an in-field relapse. Patients with partial response (PR) (n = 10) received a median whole-brain dose of 23.4 Gy with (n = 8) or without (n = 2) a boost; there were 2 relapses within the central nervous system (CNS). All PR patients were alive at the time of analysis. The overall survival (P =.127) and freedom from relapse within the CNS (P =.967) were not different for patients with CR versus PR. Baseline and follow-up neurocognitive evaluations were available for 4 PR patients, and there were no significant differences between pre- and post-treatment evaluations (P >.05 for language, memory, visual-spatial, attention, or motor functions). All patients who progressed or did not respond to chemotherapy and then received WBRT had died at a median time of 3.4 months. Patients who progressed or did not respond to chemotherapy had worse overall survival (P =.001) and freedom from CNS relapse (P =.005) compared with CR patients. Conclusions: Among patients with a PR to induction chemotherapy, reduced-dose WBRT with a boost to residual PCNSL may be a viable treatment approach that merits further investigation.
AB - Background: For patients with primary diffuse large B-cell lymphoma of the central nervous system (PCNSL), whole-brain radiation therapy (WBRT) to doses of ≥45 Gy are often given after a partial response (PR) to methotrexate-based induction chemotherapy. We conducted an exploratory analysis to determine whether lower-dose WBRT, given with a boost to sites of persistent disease, might be a reasonable alternative. Methods and materials: We retrospectively reviewed the records of 22 patients with PCNSL who received WBRT, with or without a boost, after methotrexate-based induction chemotherapy. Outcomes were compared among patients according to response to chemotherapy using the Kaplan-Meier method. Results: Median follow-up was 52 months. All patients with a complete response (CR) (n = 5) received WBRT to 23.4 Gy. One CR patient died after an in-field relapse. Patients with partial response (PR) (n = 10) received a median whole-brain dose of 23.4 Gy with (n = 8) or without (n = 2) a boost; there were 2 relapses within the central nervous system (CNS). All PR patients were alive at the time of analysis. The overall survival (P =.127) and freedom from relapse within the CNS (P =.967) were not different for patients with CR versus PR. Baseline and follow-up neurocognitive evaluations were available for 4 PR patients, and there were no significant differences between pre- and post-treatment evaluations (P >.05 for language, memory, visual-spatial, attention, or motor functions). All patients who progressed or did not respond to chemotherapy and then received WBRT had died at a median time of 3.4 months. Patients who progressed or did not respond to chemotherapy had worse overall survival (P =.001) and freedom from CNS relapse (P =.005) compared with CR patients. Conclusions: Among patients with a PR to induction chemotherapy, reduced-dose WBRT with a boost to residual PCNSL may be a viable treatment approach that merits further investigation.
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U2 - 10.1016/j.adro.2018.07.001
DO - 10.1016/j.adro.2018.07.001
M3 - Article
C2 - 30370365
AN - SCOPUS:85053293175
SN - 2452-1094
VL - 3
SP - 639
EP - 646
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 4
ER -